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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
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Fast-track thrombolysis protocol for acute limb ischemia.

Enrico Ascher1, Pavel Kibrik1, Syed Ali Rizvi1

  • 1Division of Vascular Surgery, NYU Langone Hospital-Brooklyn, Brooklyn, NY.

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|May 22, 2020
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Summary

The fast-track thrombolysis protocol for arteries (FTTP-A) effectively resolves acute lower extremity arterial occlusions in a single session for most patients. This safe and cost-effective procedure reduces complications and hospital stays for acute limb ischemia treatment.

Keywords:
Acute limb ischemiaAngioJetCatheter-directed thrombolysisFast-track thrombolysisPharmacomechanical thrombectomyStentingTissue plasminogen activator

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Area of Science:

  • Vascular Surgery
  • Interventional Radiology
  • Cardiovascular Medicine

Background:

  • Catheter-directed thrombolysis for acute lower extremity arterial occlusions often requires multiple sessions, increasing costs and complication risks.
  • Prolonged thrombolytic exposure can lead to hemorrhagic complications and extended hospital stays.
  • The fast-track thrombolysis protocol for arteries (FTTP-A) was developed to address these limitations.

Purpose of the Study:

  • To evaluate the safety, efficacy, and cost-effectiveness of the FTTP-A protocol.
  • To determine the success rate of achieving arterial patency in a single interventional session.
  • To assess the impact of FTTP-A on hospital length of stay and complication rates.

Main Methods:

  • Retrospective study of 42 patients treated with FTTP-A for acute limb ischemia between January 2014 and February 2019.
  • FTTP-A involves periadventitial lidocaine injection, contrast arteriography, pharmacomechanical rheolytic thrombectomy, tissue plasminogen activator infusion, and balloon maceration.
  • Stenting was performed if significant stenosis persisted; oral anticoagulants were prescribed post-procedure.

Main Results:

  • Single-session FTTP-A success rate was 81% (34/42 patients); 19% required one additional session.
  • Mean operative time was 148.9 minutes; mean tPA volume was 9.7 mg.
  • Mean postoperative length of stay was 3.1 days (median 1 day); no 30-day rethrombosis, limb loss, or mortality occurred. Mean cost was $4673.19 per procedure.

Conclusions:

  • FTTP-A is a safe and effective treatment for acute lower extremity arterial occlusions.
  • The protocol demonstrates significant cost-effectiveness and reduces hospital length of stay.
  • FTTP-A minimizes complications associated with prolonged thrombolytic exposure.