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Published on: February 28, 2012
Guide wire traversal test: retrospective study of results with fibrinolytic therapy
D C Smith1, M J McCormick, D A Jensen
1Department of Radiology, Loma Linda University Medical Center, CA 92354.
Insights
The guide wire traversal test is not a definitive predictor for urokinase fibrinolytic therapy success. Even if initial attempts fail, successful treatment outcomes are still achievable in many patients.
Area of Science:
- Vascular Surgery
- Interventional Radiology
- Thrombolytic Therapy
Background:
- Selective fibrinolytic infusion therapy is a treatment for clotted vessels.
- The guide wire traversal test is used to predict treatment outcomes.
Purpose of the Study:
- To investigate the validity of the guide wire traversal test as a predictor of selective fibrinolytic infusion therapy outcomes.
- To determine if initial guide wire traversal failure impacts urokinase therapy success.
Main Methods:
- Retrospective analysis of 51 consecutive urokinase infusions.
- Categorization of patients based on initial guide wire traversal success (36 patients) or failure (15 patients).
- Analysis of treatment outcomes and patient demographics for both groups.
Main Results:
- Initial guide wire traversal was successful in 36 patients and unsuccessful in 15.
- In 10 of 15 patients with initial traversal failure, successful lysis was achieved through prolonged proximal infusion or subsequent traversal.
- No significant differences in outcomes were observed between groups with successful vs. unsuccessful initial guide wire traversal.
Conclusions:
- Failure to traverse a clotted vessel with a guide wire does not preclude successful urokinase fibrinolytic therapy.
- The guide wire traversal test may not be a sole determinant of treatment success in fibrinolytic therapy.
Abstract:
The validity of the guide wire traversal test as a predictor of the outcome of selective fibrinolytic infusion therapy was investigated. A retrospective analysis of 51 consecutive urokinase infusions at the authors' institution revealed that the initial attempt at guide wire traversal of clotted vessels was successful in 36 patients and unsuccessful in 15. In those 15 patients in whom the initial guide wire traversal was unsuccessful, urokinase was infused proximal to the occlusion for 2-8 hours. In 10 of these 15 vessels, either guide wire traversal (n = 7) or complete lysis with only proximal infusion (n = 3) was then achieved. Final results for this group of 15 patients were similar to those found in the group of 36 patients in whom initial attempts at guide wire traversal were successful (chi 2 contingency analysis, P greater than .8). There were no statistically significant differences between these two groups with regard to ages of the grafts, duration of vessel occlusion prior to treatment, infusion times, or patient gender composition. These data indicate that failure to traverse a clotted vessel with a guide wire does not preclude successful urokinase fibrinolytic therapy in a substantial percentage of patients.
