The breakthroughs that have knocked down the nation’s death rate from heart disease include drugs, devices, stents and surgical strategies. And they continue.

At national cardiology conferences, “You see case after case after case of leading-edge stuff,” said Dr. Matt Johnson, a cardiologist with Bryan Heart in Lincoln.

One technique, developed by Dr. Thomas Porter of the University of Nebraska Medical Center, involves using microbubbles — tiny scrubbing bubbles — to break up blood clots in heart arteries.

Porter said the technique still needs to pass regulatory hurdles in the United States.

The procedure, which has been effective in tests involving pigs, uses ultrasound over the heart and microbubbles injected into the arm of a heart-attack patient. The microbubbles then enter small holes and cracks in the clot. When it’s shaken by the ultrasound’s sound waves, the clot breaks and the artery is reopened.

An ambulance company with a small ultrasound machine and a bottle of the microbubbles could treat a patient, Porter said.

“This is something that could be applied right away,” Porter said.

He said the U.S. Food and Drug Administration wants the strategy to be tested in a second animal model, probably rats.

The first trial involving patients is being done in Sao Paulo. Porter also hopes to try it with an ambulance service with portable ultrasound equipment in Alberta, Canada.

Numerous other innovations have been deployed within the past few years or are in the approval process. Among them:

» A dissolving stent that would absorb into the system over time so that the artery could function more normally, without the limitations of the stent. Also, a branch leading to the artery can sometimes be blocked by a stent, and a dissolvable stent would remove that barrier so the branch could carry blood to the artery. The FDA hasn’t yet approved this technology.

» An artificial heart valve, approved by the FDA in 2011, that can be delivered through an artery in the leg. The system enables cardiologists to place the valve without open-heart surgery.

» A stent that a cardiologist can place by pushing the catheter through the wrist instead of the leg artery. Johnson said this use of the “radial” artery involves less risk of bleeding and less patient discomfort.

» A small device, implanted in the pulmonary artery, that transmits blood-pressure measurements from heart-failure patients to clinics monitoring them remotely. Physicians can intervene with medicine or another strategy before a situation becomes a crisis. The FDA approved the CardioMEMS system two years ago.

» Injectable statin drugs, with the brand names Praluent and Repatha, that won approval last year from the FDA for use in some patients. The drugs may work better for some and have fewer side effects, but they cost thousands of dollars a year. Cardiologists said it can be challenging to get approval from insurers.

» The electric LUCAS 2 chest compression machine, increasingly used by emergency medical personnel to provide consistency in compressions, and which can be used while the ambulance is on its way to the hospital. The Helmsley Charitable Trust last year gave the Nebraska Department of Health and Human Services about $6 million to acquire LUCAS 2 devices for many hospitals and ambulance services.

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