Tepe G, Luz O, Hahn U, Pereira P, König C, Ziemer G, Claussen C D, Duda S H
Abteilung für Radiologische Diagnostik, Radiologische Universitätsklinik.
Rofo. 2000 Sep;172(9):780-4. doi: 10.1055/s-2000-7228.
Urokinase followed by rt-PA are the most frequently used drugs approved for thrombolysis in peripheral arteries in the USA and Europe. We wanted to test the safety and efficacy of low-dose reteplase administered by pulsed spray technique.
10 patients with acute or subacute occlusion of a peripheral artery (n = 8) or graft (n = 2) were treated (history 8 +/- 17 days; occlusion length 4-60 cm, mean 23 cm). Reteplase was administered as an intra-arterial (i.a.) bolus (0.5 U/10 cm of occlusion length) followed by pulsed spray lysis (1 U/h for the first 2 h, then 0.5 U/h). The catheter was placed into the occlusion. In addition the patients received heparin (i.a.) and aspirin (oral). The site of puncture was closed with a percutaneous suturing system prior to discontinuation of heparin treatment.
A total dose of 3.3 +/- 1.2 U reteplase was administered. The primary success rate was 7/10. Two distal embolizations and two bleeding complications were observed (one minor bleeding at the site of puncture and one rupture of the suture which had to be treated surgically).
With regard to our limited data, low-dose i.a. reteplase seems to be safe and effective. Two bleeding complications were observed which both occurred at the site of puncture. Discontinuation of heparin treatment prior to sheath removal is recommended. Fibrinolysis with reteplase may be an alternative to urokinase or rt-PA.
在美国和欧洲，尿激酶后接重组人组织型纤溶酶原激活剂（rt-PA）是外周动脉溶栓最常用的获批药物。我们想测试通过脉冲喷射技术给予低剂量瑞替普酶的安全性和有效性。
10例外周动脉（n = 8）或移植物（n = 2）急性或亚急性闭塞患者接受治疗（病史8±17天；闭塞长度4 - 60 cm，平均23 cm）。瑞替普酶作为动脉内（i.a.）推注给药（每10 cm闭塞长度0.5 U），随后进行脉冲喷射溶栓（最初2小时1 U/h，然后0.5 U/h）。将导管置于闭塞处。此外，患者接受肝素（动脉内给药）和阿司匹林（口服）。在停止肝素治疗前，用经皮缝合系统封闭穿刺部位。
共给予瑞替普酶3.3±1.2 U。主要成功率为7/10。观察到2例远端栓塞和2例出血并发症（1例穿刺部位轻微出血，1例缝线破裂需手术治疗）。
就我们有限的数据而言，低剂量动脉内给予瑞替普酶似乎安全有效。观察到2例出血并发症，均发生在穿刺部位。建议在拔除鞘管前停止肝素治疗。瑞替普酶溶栓可能是尿激酶或rt-PA的替代方法。
