The utilization of ultrasound and microbubbles for therapy in acute coronary syndromes

Ultrasound has become a useful high resolution imaging modality for examining the cardiac microcirculation. With the use of microbubbles as an ultrasound contrast agent, ultrasound can be utilized to image the microcirculation and detect capillary flow abnormalities in acute ischaemia. A wide range of ultrasound frequencies (including those used for diagnostic transthoracic imaging) have also been utilized therapeutically to augment the effectiveness of fibrinolytic therapy in ST-segment elevation myocardial infarction (STEMI). Ultrasound and microbubbles are now being explored as methods of improving both microcirculatory and epicardial flow in acute STEMI. This article will review the mechanisms by which ultrasound and microbubbles assist in thrombus detection and dissolution. In addition, the pre-clinical studies utilizing transthoracic ultrasound as a therapeutic entity in acute STEMI will be reviewed. Clinical studies, completed and ongoing, will also be presented.