Sonoreperfusion Therapy for Microvascular Obstruction: A Review

Coronary artery disease and acute myocardial infarction are a leading cause of morbidity and mortality. Contemporary therapy is percutaneous coronary intervention (PCI), performed by balloon angioplasty and stent placement. PCI is nearly ubiquitously accompanied by some degree of microvascular obstruction (MVO), and in many cases characterized by poor microvascular perfusion of myocardium distal to the site of primary occlusion. This phenomenon, also termed “no reflow”, was first documented in 1974 [1]. MVO is a powerful independent predictor of mortality, independent of age, infarct size, or ejection fraction [2]. Ultrasound targeted microbubble cavitation, termed “sonoreperfusion therapy”, is a promising treatment option to relieve MVO and reestablish microvascular perfusion. The purpose of this review is to discuss the pathophysiology of MVO and the clinical translation of sonoreperfusion therapy.