Thrombolysis for acute lower limb arterial embolism in patients with recent cerebral embolism / 介入放射学杂志

ABSTRACT

Objective To assess the feasibility and efficacy of catheter-directed thrombolysis with recombinant tissue plasminogen activator(rt-PA)for acute limb embolism in patients with recent cerebral embolism.Methods Eight patients with atrial fibrillation history happened to suffer acute limb embolism after recent cerebral embolism.The affected arteries included 2 left common iliac arteries,4 femoral arteries(3 left,1 right),2 right popliteal arteries.Catheter-directed thrombolysis with rt-PA was applied with bolus administration plus continuous perfusion.Percutanous transluminal angioplasty with balloon dilatation was applied in 3 patients,and one stent placement in one patient.Results The mean duration of continous perfusion was 3.6 hours and the mean dose of rt-PA administered was 23.6 mg(range,20 ～ 28 mg)with complete recanalization rate of 100%.Clinical complete relief rate was 7/8 with one patient suffering from rest pain due to distal occlusion of anterior/posterior tibial artery.The complications included hematoma at puncture site(6/8),bleeding around the vascular sheath(2/8)and hematuria(1/8).No intracerebral hemorrhage was found on CT scans after the thrombolysis.During follow up of 3-6 months,no recurrent embolism or thrombosis occurred in the limbs except one patient with recurrent cerebral embolism and died.Conclusions Catheter-directed thrombolysis with rt-PA is probably to be a safe and effective method for acute limb embolism in patients with recent cerebral embolism and atrial fibrillation history.