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Combined Focused Ultrasound and Electrohydraulic Shock Wave Thrombolytic Therapy Accompanied by Tissue Plasminogen Activator Administration Reduce Thrombus Content in the Arterial Atherothrombotic Stenosis

1Islamic Azad University, Basic Sciences Faculty, Department of Physics, Tabriz Branch, Tabriz, Iran, Islamic Republic of, 2Mehrad Research Lab, Division of Translational Development of Noninvasive Treatments, Tabriz, Iran, Islamic Republic of, 3Italian National Research Council, Institute of Translational Pharmacology IFT, Rome, Italy

Abstract Number: PB0009

Meeting: ISTH 2021 Congress

Theme: Arterial Thromboembolism » Atherosclerosis

Background: Vascular disease arises through the complications of atherosclerosis, a complex chronic inflammatory condition affecting the arterial circulation. It leads to the development of vascular lesions or soft atherosclerotic plaques, which manifest as asymmetrical thickenings of the intima of medium to large sized elastic and muscular arteries. A soft plaque may rupture with high risk of subsequent thrombus mediated acute clinical events such as myocardial infarction and stroke.

Aims: The aim of this study was to generate a hamster model of common carotid artery atherothrombotic stenosis and the subsequent investigating the feasibility of combined focused ultrasound and electrohydraulic shock wave – mediated thrombolytic therapy accompanied by tissue plasminogen activator (tPA) administration in this model.

Methods: Briefly, golden Syrian hamsters were submitted to common carotid artery atherothrombotic stenosis by primary balloon injury followed 2% cholesterol- rich diet injury for eight weeks and finally perivascular liquid nitrogen- mediated severe cold injury. Then treatment group underwent combined focused ultrasound (I= 24 W/cm2, F= 1.2MHz, PD= 120 ms) and electrohydraulic shock wave (V= 15 Kv, F= 0.3Hz, Impulses= 100) – mediated thrombolytic therapy accompanied by tPA (0.6 mg/kg) administration.

Results: Results from histopathology, B-mode and color Doppler ultrasonography, showed a significant reduction in the mean value for thrombus content, blood mean velocity and a significant increase in the mean value for blood volume flow at the stenotic region in the treatment group compared with the other groups (P<0.05).

Conclusions: Focal thrombus disruption mechanism was partly clarified as originated from microjet formation upon bubble collapse. Enhanced anti- thrombotic effect of tPA, due to enhanced microjets, induced by combined focused ultrasound and electrohydraulic shock wave therapy, can cause to reduce the thrombus content and significantly dilate the luminal cross-sectional area of stenosis and lower treatment time in comparison with conventional tPA thrombolytic therapy.

To cite this abstract in AMA style:

Mehrad H, Foletti A. Combined Focused Ultrasound and Electrohydraulic Shock Wave Thrombolytic Therapy Accompanied by Tissue Plasminogen Activator Administration Reduce Thrombus Content in the Arterial Atherothrombotic Stenosis [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 1). https://abstracts.isth.org/abstract/combined-focused-ultrasound-and-electrohydraulic-shock-wave-thrombolytic-therapy-accompanied-by-tissue-plasminogen-activator-administration-reduce-thrombus-content-in-the-arterial-atherothrombotic-ste/. Accessed September 24, 2021.

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