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Detection of left heart thrombus by echocardiography is not essential before peripheral arterial thrombolysis
R J Lonsdale1, D C Berridge, G S Makin
1Department of Vascular Surgery, University Hospital, Nottingham, UK.
Insights
Left heart thrombus is not a contraindication to thrombolysis. Echocardiography before thrombolysis in peripheral arterial occlusion patients showed safe and effective treatment, even with identified left heart thrombus.
Area of Science:
- Cardiology
- Vascular Medicine
- Medical Imaging
Background:
- Left heart thrombus has historically been considered a contraindication for thrombolysis.
- Peripheral arterial occlusion necessitates effective treatment strategies.
Purpose of the Study:
- To evaluate the role of echocardiography in cardiac assessment before thrombolysis for peripheral arterial occlusion.
- To determine the safety and efficacy of thrombolysis in patients with left heart thrombus.
Main Methods:
- Prospective study involving 51 patients undergoing thrombolysis for peripheral arterial occlusion.
- Echocardiography performed for cardiac assessment prior to thrombolysis.
- Comparison of recanalization rates and embolic complications between thrombotic and embolic occlusions.
Main Results:
- Ten patients (19.6%) had positive echocardiograms indicating potential left heart thrombus.
- Echocardiography aided in diagnosing embolus in one patient.
- Successful recanalization rate was 100% in patients with embolic occlusions versus 58% in thrombotic occlusions.
- No embolic complications occurred during or within 30 days of thrombolytic treatment.
Conclusions:
- Thrombolysis can be safely administered in patients with peripheral arterial occlusion, even in the presence of left heart thrombus.
- Echocardiography is valuable in assessing cardiac risks before thrombolysis.
- Embolic occlusions demonstrated higher recanalization success rates with thrombolysis compared to thrombotic occlusions.
Abstract:
Left heart thrombus has been regarded as a contraindication to thrombolysis. In this prospective study the role of echocardiography before thrombolysis in the cardiac assessment of 51 patients undergoing thrombolysis for a peripheral arterial occlusion was evaluated. Ten patients with positive echocardiograms were identified. Echocardiography contributed to the diagnosis of embolus in one patient. All eight patients with embolic arterial occlusions were successfully recanalized, comparing favourably with a success rate of 58% in patients with thrombotic occlusions. There were no embolic complications during thrombolytic treatment or in the subsequent 30 days. We conclude that thrombolysis can be performed safely despite the presence of left heart thrombus.