ABSTRACT
The novel power-pulse spray (P-PS) technique maximizes and combines the advantages and minimizes the disadvantages of both chemical thrombolysis (CT) and rheolytic thrombectomy (RT). Forty-nine consecutive patients with iliofemoral thrombotic occlusion were treated via P-PS technique. Using a 6 Fr RT catheter, saline prime was exchanged for thrombolytic solution [group 1, 10-20 mg tenecteplase (TNK)/50 cc saline, n = 25; group 2, 1,000,000 urokinase (UK)/50 cc saline, n = 24]. The outflow port was closed, then the catheter was advanced at 1 mm increments while pulsing lytic agent. After 30-min lysis time, RT and definitive treatment of the underlying stenosis were performed. Procedure success was 23/25 (92%) and 22/24 (91.6%) for group 1 and 2, respectively. The mean total procedure time was 72 and 75 min in group 1 and 2, respectively. Thirty-day limb salvage was 91% in both groups. There were no major surgical complications. The P-PS technique is safe and effective using either UK or TNK, offering several potential advantages over monotherapy, including more rapid revascularization, decreases systemic lytic exposure and bleeding complications while facilitating both CT and RT capacity and efficacy.
Subject(s)
Ischemia/therapy , Lower Extremity/blood supply , Lower Extremity/surgery , Thrombectomy , Thrombolytic Therapy , Acute Disease , Aged , Aged, 80 and over , Angiography , Arterial Occlusive Diseases/therapy , Combined Modality Therapy/methods , Dose-Response Relationship, Drug , Female , Femoral Vein/pathology , Femoral Vein/surgery , Fibrinolytic Agents/therapeutic use , Follow-Up Studies , Humans , Iliac Artery/pathology , Iliac Artery/surgery , Ischemia/diagnostic imaging , Ischemia/surgery , Lower Extremity/diagnostic imaging , Male , Middle Aged , Multivariate Analysis , Plasminogen Activators/therapeutic use , Popliteal Artery/pathology , Popliteal Artery/surgery , Retrospective Studies , Tenecteplase , Thrombectomy/methods , Thrombolytic Therapy/methods , Tissue Plasminogen Activator/therapeutic use , Treatment Outcome , Urokinase-Type Plasminogen Activator/therapeutic useABSTRACT
PURPOSE: To evaluate a continuous-infusion protocol for peripheral arterial thrombolysis using tenecteplase (TNK), with regard to the technique, dosing, infusion times, and clinical outcomes. METHODS: Between November 1999 and July 2002, 48 patients (30 men; mean age 68.5+/-11.9 years) presented with acute limb ischemia (ALI) owing to iliofemoral arterial thrombosis, which was treated with continuous TNK infusion (either 0.50 mg/h [n=22, group A] or 0.25 mg/h [n=26, group B]). All patients received periprocedural heparin (500 U/h) and peri and postprocedural tirofiban for 6 to 12 hours. Follow-up included ankle-brachial index and duplex ultrasound at baseline, 1 month, and 6 months. The variables retrospectively analyzed included total infusion time, total TNK dose, fibrinogen analysis, clinical and thrombolysis outcomes, and complications. RESULTS: The overall clinical procedural success was 95.8%. Complete (>95%) lysis was observed in 35 (73%) patients; overall mean infusion time was 7.5 hours, and overall mean TNK dose was 4.8 mg. No deaths, intracranial bleeding, or embolic events occurred in either group. Of the 8 (16.7%) complications, 5 (10.4%) were major: 1 femoral repair (group A), 2 >5-cm nonsurgical hematomas (1 in each group), and 2 gastrointestinal hemorrhages (1 in each group). The 3 (6.3%) minor complications were minor hematomas (2 in group A and 1 in group B). The 30-day and 14-month mean limb salvage rates were 95.8% (46/ 48) and 89.6% (43/48), respectively. CONCLUSIONS: Continuous TNK infusion (0.25-0.50 mg/h) is a safe and feasible treatment for continuous pharmacological thrombolysis in ALI, potentially offering decreased infusion times and bleeding complications, as well as improved outcomes.
Subject(s)
Fibrinolytic Agents/administration & dosage , Ischemia/drug therapy , Leg/blood supply , Thrombolytic Therapy/methods , Tissue Plasminogen Activator/administration & dosage , Tyrosine/analogs & derivatives , Aged , Drug Therapy, Combination , Feasibility Studies , Female , Follow-Up Studies , Humans , Infusions, Intravenous , Ischemia/etiology , Male , Middle Aged , Platelet Glycoprotein GPIIb-IIIa Complex/antagonists & inhibitors , Retrospective Studies , Tenecteplase , Thrombosis/complications , Thrombosis/drug therapy , Tirofiban , Treatment Outcome , Tyrosine/administration & dosageABSTRACT
PURPOSE: To report the technique of carotid endarterectomy (CEA) combined with retrograde balloon angioplasty and stenting of proximal "tandem" lesions in the supra-aortic trunk. TECHNIQUE: Intraoperative techniques in 34 patients with 23 left common carotid artery (CCA) and 11 innominate artery lesions included general anesthesia, low-dose dextran, prosthetic patching, selective shunting, 8-F sheath entry into the native CCA before the CEA, manual CCA sizing, and balloon-expandable stent placement after predilation. The technique has a high procedural success rate (97%) and appears durable. Over a mean 34-month follow-up, 2 >70% ostial CCA restenoses were found at 24 months. CONCLUSIONS: Intraoperative innominate or left CCA balloon angioplasty/stenting combined with carotid endarterectomy is safe, effective, and durable.
