1
|
Iqbal MF, Shafique MA, Abdur Raqib M, Fadlalla Ahmad TK, Haseeb A, M. A. Mhjoob A, Raja A. Histotripsy: an innovative approach for minimally invasive tumour and disease treatment. Ann Med Surg (Lond) 2024; 86:2081-2087. [PMID: 38576932 PMCID: PMC10990312 DOI: 10.1097/ms9.0000000000001897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 02/26/2024] [Indexed: 04/06/2024] Open
Abstract
Histotripsy is a noninvasive medical technique that uses high-intensity focused ultrasound (HIFU) to treat liver tumours. The two main histotripsy methods are boiling histotripsy and cavitation cloud histotripsy. Boiling histotripsy uses prolonged ultrasound pulses to create small boiling bubbles in the tissue, which leads to the breakdown of the tissue into smaller subcellular fragments. Cavitation cloud histotripsy uses the ultrasonic cavitation effect to disintegrate target tissue into precisely defined liquefied lesions. Both methods show similar treatment effectiveness; however, boiling histotripsy ensures treatment stability by producing a stable boiling bubble with each pulse. The therapeutic effect is ascribed to mechanical damage at the subcellular level rather than thermal damage. This article discusses the mechanisms, treatment parameters, and potential of histotripsy as a minimally invasive procedure that provides precise and controlled subcellular damage.
Collapse
Affiliation(s)
| | | | | | | | - Abdul Haseeb
- Department of Medicine, Jinnah Sindh Medical University
| | | | - Adarsh Raja
- Department of Medicine, Shaheed Mohtarma Benazir Bhutto Medical College, Karachi, Pakistan
| |
Collapse
|
2
|
Verma Y, Arachchige ASPM. Revolutionizing cardiovascular care: the power of histotripsy. J Ultrasound 2024:10.1007/s40477-023-00848-7. [PMID: 38217765 DOI: 10.1007/s40477-023-00848-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 11/13/2023] [Indexed: 01/15/2024] Open
Abstract
Histotripsy, an innovative ultrasonic technique, is poised to transform the landscape of cardiovascular disease management. This review explores the multifaceted applications of histotripsy across various domains of cardiovascular medicine. In thrombolysis, histotripsy presents a non-invasive, drug-free, and precise method for recanalizing blood vessels obstructed by clots, minimizing the risk of vessel damage and embolism. Additionally, histotripsy showcases its potential in congenital heart defect management, offering a promising alternative to invasive procedures by creating intracardiac communications noninvasively. For patients with calcified aortic stenosis, histotripsy demonstrates its effectiveness in softening calcified bioprosthetic valves, potentially revolutionizing valve interventions. In the realm of arrhythmias, histotripsy could play an important role in scar-based ventricular tachycardia ablation, eliminating channel-like isthmuses of slowly conducting myocardium. Histotripsy`s potential applications also extend to structural heart interventions, enabling the safe sectioning of basal chordae and potentially addressing mitral regurgitation. Furthermore, it showcases its versatility by safely generating ventricular septal defects, providing a non-invasive means of creating intracardiac communications in neonates with congenital heart disease. Yet, most supporting studies are in-vitro or animal studies and there are possible challenges in translating experimental data on cardiac histotripsy to the clinical level. As histotripsy continues to evolve and mature, its remarkable potential in cardiovascular disease management holds promise for improving patient outcomes and reducing the burden of invasive procedures in the field of cardiology.
Collapse
Affiliation(s)
- Yash Verma
- Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, UK
| | | |
Collapse
|
3
|
Messas E, Ijsselmuiden A, Trifunović-Zamaklar D, Cholley B, Puymirat E, Halim J, Karan R, van Gameren M, Terzić D, Milićević V, Tanter M, Pernot M, Goudot G. Treatment of severe symptomatic aortic valve stenosis using non-invasive ultrasound therapy: a cohort study. Lancet 2023; 402:2317-2325. [PMID: 37972628 DOI: 10.1016/s0140-6736(23)01518-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 07/13/2023] [Accepted: 07/18/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Calcific aortic stenosis is commonly treated using surgical or transcatheter aortic valve replacement; however, many patients are not considered suitable candidates for these interventions due to severe comorbidities and limited life expectancy. As such, non-invasive therapies might offer alternative therapeutic possibilities in these patients. This study aimed to assess the safety of non-invasive ultrasound therapy and its ability to improve valvular function by softening calcified valve tissue. METHODS This prospective, multicentre, single-arm series enrolled 40 adult patients with severe symptomatic aortic valve stenosis at three hospitals in France, the Netherlands, and Serbia between March 13, 2019, and May 8, 2022. Patients were treated with transthoracically delivered non-invasive ultrasound therapy. Follow-ups were scheduled at 1, 3, 6, 12, and 24 months. The primary endpoints were procedure-related deaths within 30 days and improved valve function. We report the 6-month data. This study is registered at ClinicalTrials.gov, NCT03779620 and NCT04665596. FINDINGS 40 high-risk patients with a mean Society of Thoracic Surgeons score of 5·6% (SD 4·4) and multiple severe comorbidities were included. The primary endpoint, procedure-related mortality, did not occur; furthermore, no life-threatening or cerebrovascular events were reported. Improved valve function was confirmed up to 6 months, reflected by a 10% increase in mean aortic valve area from 0·58 cm2 (SD 0·19) at baseline to 0·64 cm2 (0·21) at follow-up (p=0·0088), and a 7% decrease in mean pressure gradient from 41·9 mm Hg (20·1) to 38·8 mm Hg (17·8; p=0·024). At 6 months, the New York Heart Association score had improved or stabilised in 24 (96%) of 25 patients, and the mean Kansas City Cardiomyopathy Questionnaire score had improved by 33%, from 48·5 (SD 22·6) to 64·5 (21·0). One serious procedure-related adverse event occurred in a patient who presented with a transient decrease in peripheral oxygen saturation. Non-serious adverse events included pain, discomfort during treatment, and transient arrhythmias. INTERPRETATION This novel, non-invasive ultrasound therapy for calcified aortic stenosis proved to be safe and feasible. FUNDING Cardiawave.
Collapse
Affiliation(s)
- Emmanuel Messas
- Cardiovascular Department, Hôpital Européen Georges-Pompidou, Université Paris-Cité, Paris, France; Paris Cardiovascular Research Center, Inserm UMR_U970, Université Paris-Cité, Paris, France; STOP-AS Research Consortium, Recherche Hospitalo-Universitaire, Rouen, France.
| | | | - Danijela Trifunović-Zamaklar
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia; Clinic for Cardiology, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Bernard Cholley
- Department of Anaesthesiology and Intensive Care Medicine, Hôpital Européen Georges-Pompidou, Université Paris-Cité, Paris, France; Innovative Therapies in Haemostasis, Inserm UMR_S1140, Université Paris-Cité, Paris, France
| | - Etienne Puymirat
- Cardiovascular Department, Hôpital Européen Georges-Pompidou, Université Paris-Cité, Paris, France; Paris Cardiovascular Research Center, Inserm UMR_U970, Université Paris-Cité, Paris, France
| | - Jonathan Halim
- Cardiology Department, Amphia Hospital, Breda, Netherlands
| | - Radmila Karan
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia; Department of Anaesthesiology and Intensive Care at Clinic for Cardiac Surgery, University Clinical Centre of Serbia, Belgrade, Serbia
| | | | - Duško Terzić
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia; Clinic for Cardiac Surgery, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Vladimir Milićević
- Clinic for Cardiac Surgery, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Mickael Tanter
- Physics for Medicine Paris, Inserm/ESPCI Paris-PSL/CRNS, Paris, France
| | - Mathieu Pernot
- Physics for Medicine Paris, Inserm/ESPCI Paris-PSL/CRNS, Paris, France
| | - Guillaume Goudot
- Cardiovascular Department, Hôpital Européen Georges-Pompidou, Université Paris-Cité, Paris, France
| |
Collapse
|
4
|
Di Mario C, Mattesini A. Non-invasive high-energy ultrasound: alternative treatment before transcatheter aortic valve implantation? Lancet 2023; 402:2267-2269. [PMID: 37972627 DOI: 10.1016/s0140-6736(23)02186-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 09/25/2023] [Indexed: 11/19/2023]
Affiliation(s)
- Carlo Di Mario
- Structural Interventional Cardiology Unit, Department of Clinical and Experimental Medicine, Careggi University Hospital, University of Florence, Florence 50134, Italy.
| | - Alessio Mattesini
- Structural Interventional Cardiology Unit, Department of Clinical and Experimental Medicine, Careggi University Hospital, University of Florence, Florence 50134, Italy
| |
Collapse
|
5
|
Gunderman A, Montayre R, Ranjan A, Chen Y. Review of Robot-Assisted HIFU Therapy. SENSORS (BASEL, SWITZERLAND) 2023; 23:3707. [PMID: 37050766 PMCID: PMC10098661 DOI: 10.3390/s23073707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 03/07/2023] [Accepted: 03/14/2023] [Indexed: 06/19/2023]
Abstract
This paper provides an overview of current robot-assisted high-intensity focused ultrasound (HIFU) systems for image-guided therapies. HIFU is a minimally invasive technique that relies on the thermo-mechanical effects of focused ultrasound waves to perform clinical treatments, such as tumor ablation, mild hyperthermia adjuvant to radiation or chemotherapy, vein occlusion, and many others. HIFU is typically performed under ultrasound (USgHIFU) or magnetic resonance imaging guidance (MRgHIFU), which provide intra-operative monitoring of treatment outcomes. Robot-assisted HIFU probe manipulation provides precise HIFU focal control to avoid damage to surrounding sensitive anatomy, such as blood vessels, nerve bundles, or adjacent organs. These clinical and technical benefits have promoted the rapid adoption of robot-assisted HIFU in the past several decades. This paper aims to present the recent developments of robot-assisted HIFU by summarizing the key features and clinical applications of each system. The paper concludes with a comparison and discussion of future perspectives on robot-assisted HIFU.
Collapse
Affiliation(s)
- Anthony Gunderman
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA 30332, USA
| | - Rudy Montayre
- Department of Physiological Sciences, College of Veterinary Medicine, Oklahoma State University, Stillwater, OK 74078, USA
| | - Ashish Ranjan
- Department of Physiological Sciences, College of Veterinary Medicine, Oklahoma State University, Stillwater, OK 74078, USA
| | - Yue Chen
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA 30332, USA
| |
Collapse
|
6
|
Ditac G, Bessière F, Lafon C. Therapeutic ultrasound applications in cardiovascular diseases: a review. Ing Rech Biomed 2022. [DOI: 10.1016/j.irbm.2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
7
|
Smadja DM, Goudot G, Gendron N, Zarka S, Puymirat E, Philippe A, Spaulding C, Peronino C, Tanter M, Pernot M, Messas E. Von Willebrand factor multimers during non-invasive ultrasound therapy for aortic valve stenosis. Angiogenesis 2021; 24:715-717. [PMID: 34101096 DOI: 10.1007/s10456-021-09803-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 05/20/2021] [Indexed: 11/24/2022]
Affiliation(s)
- David M Smadja
- Paris University, Innovative Therapies in Hemostasis, INSERM, F-75006, Paris, France.
- Hematology Department and Biosurgical Research Lab (Carpentier Foundation), AP-HP, Georges Pompidou European Hospital, 20 rue Leblanc, F-75015, Paris, France.
| | - Guillaume Goudot
- Vascular Medicine Department, AP-HP, Paris University, Georges Pompidou European Hospital, 75015, Paris, France
- UMR 970 PARCC INSERM, Paris University, Paris, France
| | - Nicolas Gendron
- Paris University, Innovative Therapies in Hemostasis, INSERM, F-75006, Paris, France
- Hematology Department and Biosurgical Research Lab (Carpentier Foundation), AP-HP, Georges Pompidou European Hospital, 20 rue Leblanc, F-75015, Paris, France
| | - Samuel Zarka
- Vascular Medicine Department, AP-HP, Paris University, Georges Pompidou European Hospital, 75015, Paris, France
- UMR 970 PARCC INSERM, Paris University, Paris, France
| | - Etienne Puymirat
- UMR 970 PARCC INSERM, Paris University, Paris, France
- Cardiology Department, AP-HP, Paris University, Georges Pompidou European Hospital, 75015, Paris, France
| | - Aurélien Philippe
- Paris University, Innovative Therapies in Hemostasis, INSERM, F-75006, Paris, France
- Hematology Department and Biosurgical Research Lab (Carpentier Foundation), AP-HP, Georges Pompidou European Hospital, 20 rue Leblanc, F-75015, Paris, France
| | - Christian Spaulding
- Cardiology Department, AP-HP, Paris University, Georges Pompidou European Hospital, 75015, Paris, France
| | - Christophe Peronino
- Paris University, Innovative Therapies in Hemostasis, INSERM, F-75006, Paris, France
| | - Mickael Tanter
- Physics for Medicine, U1273 INSERM, ESPCI Paris, CNRS, PSL Research University, Paris, France
| | - Mathieu Pernot
- Physics for Medicine, U1273 INSERM, ESPCI Paris, CNRS, PSL Research University, Paris, France
| | - Emmanuel Messas
- Vascular Medicine Department, AP-HP, Paris University, Georges Pompidou European Hospital, 75015, Paris, France
- UMR 970 PARCC INSERM, Paris University, Paris, France
| |
Collapse
|
8
|
Messas E, IJsselmuiden A, Goudot G, Vlieger S, Zarka S, Puymirat E, Cholley B, Spaulding C, Hagège AA, Marijon E, Tanter M, Bertrand B, Rémond MC, Penot R, Ren B, den Heijer P, Pernot M, Spaargaren R. Feasibility and Performance of Noninvasive Ultrasound Therapy in Patients With Severe Symptomatic Aortic Valve Stenosis: A First-in-Human Study. Circulation 2021; 143:968-970. [PMID: 33486971 DOI: 10.1161/circulationaha.120.050672] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Emmanuel Messas
- Cardiovascular Department (E. Messas, G.G., S.Z., E.P., B.C., C.S., A. A.A.H., E. Marijon), APHP Université de Paris, France.,French Research Consortium RHU STOP-AS, Rouen, France. (E. Messas, B.B., M.C.R., R.P., R.S.)
| | | | - Guillaume Goudot
- Cardiovascular Department (E. Messas, G.G., S.Z., E.P., B.C., C.S., A. A.A.H., E. Marijon), APHP Université de Paris, France
| | - Selina Vlieger
- Heart Center, Amphia Hospital, Breda, The Netherlands (A.I., S.V., P.d.H.)
| | - Samuel Zarka
- Cardiovascular Department (E. Messas, G.G., S.Z., E.P., B.C., C.S., A. A.A.H., E. Marijon), APHP Université de Paris, France
| | - Etienne Puymirat
- Cardiovascular Department (E. Messas, G.G., S.Z., E.P., B.C., C.S., A. A.A.H., E. Marijon), APHP Université de Paris, France
| | - Bernard Cholley
- Cardiovascular Department (E. Messas, G.G., S.Z., E.P., B.C., C.S., A. A.A.H., E. Marijon), APHP Université de Paris, France.,Anesthesiology and Critical Care Department, Hôpital Européen Georges-Pompidou (B.C.), APHP Université de Paris, France
| | - Christian Spaulding
- Cardiovascular Department (E. Messas, G.G., S.Z., E.P., B.C., C.S., A. A.A.H., E. Marijon), APHP Université de Paris, France
| | - Albert A Hagège
- Cardiovascular Department (E. Messas, G.G., S.Z., E.P., B.C., C.S., A. A.A.H., E. Marijon), APHP Université de Paris, France
| | - Eloi Marijon
- Cardiovascular Department (E. Messas, G.G., S.Z., E.P., B.C., C.S., A. A.A.H., E. Marijon), APHP Université de Paris, France
| | - Mickael Tanter
- Physics for Medicine, U1273 INSERM, ESPCI Paris, CNRS, PSL Research University, France (M.T., M.P.)
| | - Benjamin Bertrand
- Cardiawave, Paris, France (B.B., M.C.R., R.P., R.S.).,French Research Consortium RHU STOP-AS, Rouen, France. (E. Messas, B.B., M.C.R., R.P., R.S.)
| | - Mathieu C Rémond
- Cardiawave, Paris, France (B.B., M.C.R., R.P., R.S.).,French Research Consortium RHU STOP-AS, Rouen, France. (E. Messas, B.B., M.C.R., R.P., R.S.)
| | - Robin Penot
- Cardiawave, Paris, France (B.B., M.C.R., R.P., R.S.).,French Research Consortium RHU STOP-AS, Rouen, France. (E. Messas, B.B., M.C.R., R.P., R.S.)
| | - B Ren
- Cardialysis, Rotterdam, The Netherlands (B.R.)
| | - Peter den Heijer
- Heart Center, Amphia Hospital, Breda, The Netherlands (A.I., S.V., P.d.H.)
| | - Mathieu Pernot
- Physics for Medicine, U1273 INSERM, ESPCI Paris, CNRS, PSL Research University, France (M.T., M.P.)
| | - René Spaargaren
- Cardiawave, Paris, France (B.B., M.C.R., R.P., R.S.).,French Research Consortium RHU STOP-AS, Rouen, France. (E. Messas, B.B., M.C.R., R.P., R.S.)
| |
Collapse
|
9
|
Xu Z, Hall TL, Vlaisavljevich E, Lee FT. Histotripsy: the first noninvasive, non-ionizing, non-thermal ablation technique based on ultrasound. Int J Hyperthermia 2021; 38:561-575. [PMID: 33827375 PMCID: PMC9404673 DOI: 10.1080/02656736.2021.1905189] [Citation(s) in RCA: 93] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 02/23/2021] [Accepted: 03/12/2021] [Indexed: 01/09/2023] Open
Abstract
Histotripsy is the first noninvasive, non-ionizing, and non-thermal ablation technology guided by real-time imaging. Using focused ultrasound delivered from outside the body, histotripsy mechanically destroys tissue through cavitation, rendering the target into acellular debris. The material in the histotripsy ablation zone is absorbed by the body within 1-2 months, leaving a minimal remnant scar. Histotripsy has also been shown to stimulate an immune response and induce abscopal effects in animal models, which may have positive implications for future cancer treatment. Histotripsy has been investigated for a wide range of applications in preclinical studies, including the treatment of cancer, neurological diseases, and cardiovascular diseases. Three human clinical trials have been undertaken using histotripsy for the treatment of benign prostatic hyperplasia, liver cancer, and calcified valve stenosis. This review provides a comprehensive overview of histotripsy covering the origin, mechanism, bioeffects, parameters, instruments, and the latest results on preclinical and human studies.
Collapse
Affiliation(s)
- Zhen Xu
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Timothy L. Hall
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Eli Vlaisavljevich
- Department of Biomedical Engineering and Mechanics, Virginia Polytechnic Institute and State University, Blacksburg, VA, USA
| | - Fred T. Lee
- Departments of Radiology, Biomedical Engineering, and Urology, University of Wisconsin, Madison, WI, USA
| |
Collapse
|