Sonothrombolysis for novel adjuvant therapy in ST-elevation myocardial infarction: a systematic review

Current standard ST-segment elevation myocardial infarction (STEMI) treatments, such as percutaneous coronary intervention (PCI) and thrombolytic agent administration, still have some limitations. Sonothrombolysis is a new therapeutic modality that utilizes ultrasound energy to break up thrombus and is currently considered a promising alternative therapeutic strategy to treat STEMI. This systematic review aims to further review the clinical application of sonothrombolysis as an adjuvant therapy modality in STEMI based on the evidence available in the last ten years. We systematically searched studies on PubMed, Cochrane Library, and ScienceDirect databases. After removing duplicates and screening studies based on inclusion and exclusion criteria, data extraction and critical appraisal were performed by three independent reviewers. Study search and selection resulted in five studies with 614 patients and an additional 273 patients as a reference group. Results showed that patients treated with an intermittent, short pulse, and high mechanical index sonothrombolysis with microbubble infusion had significantly better ST-segment resolution and vessel recanalization rates than the other treatment groups. In addition, there was no significant difference in the safety level among all intervention groups. In conclusion, sonotrombolysis is a promising novel therapy that is an adjunct to PCI, which is effective and safe for treating STEMI.