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[Low dose thrombolytic treatment for revascularisation in arterial occlusion (author's transl)]
Insights
This study shows direct catheter-delivered thrombolysis with streptokinase or urokinase effectively dissolves acute and subacute arterial occlusions. Adjunctive angioplasty and antiplatelet therapy aid in revascularization and preventing reocclusion.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Thrombolytic Therapy
Context:
- Acute and subacute arterial occlusions pose significant challenges in vascular treatment.
- Traditional interventions may have limitations for extensive occlusions.
Purpose:
- To evaluate the efficacy of direct catheter-directed thrombolysis using streptokinase or urokinase for arterial occlusions.
- To assess the utility of simultaneous Grüntzig catheter angioplasty for stenoses.
- To determine the effectiveness of this approach in achieving revascularization and preventing reocclusion.
Summary:
- Eleven patients with arterial occlusions (4.5-29 cm) were treated with direct thrombolysis via catheter, using 4000-110,000 U of streptokinase or urokinase.
- Grüntzig catheter angioplasty was performed concurrently to address stenoses.
- Successful revascularization was achieved in most cases, with some recurrences in femoro-popliteal occlusions requiring further management.
- Transient systemic side effects were minimal, primarily related to lysis and coagulation disturbances.
Impact:
- Direct catheter thrombolysis offers a minimally invasive option for extensive arterial occlusions.
- Combined lysis and angioplasty can improve luminal patency and restore blood flow.
- Long-term management with antiplatelet agents is crucial for preventing reocclusion and ensuring sustained patency.
Abstract:
Acute and subacute arterial occlusions of between 4.5 and 29 cm long could be dissolved in 11 patients by infiltration of small amounts (4000 to 110 000 U) of streptokinase or urokinase directly into the thrombus using a catheter. Use of a Grüntzig catheter enabled dilatation of possible stenoses during the same session. In 3 femoro-popliteal obliterations where lysis and catheter dilatation did not lead to sufficiently patent lumina occlusion recurred. In 3 patients with wide-ranging obliteration of the femoral, popliteal and almost all the arteries of the calf almost complete revascularisation could be achieved. Only transient slight side effects of lysis and coagulation disturbances were observed systemically. For prophylaxis of reobliteration platelet aggregation inhibitors are given for pre- and long-term aftercare.