Tsetis Dimitrios K, Kochiadakis George E, Hatzidakis Adam A, Skalidis Emannuel I, Chryssou Evangelia G, Tritou Ioanna N, Vardas Panos E, Gourtsoyiannis Nicholas C
Medical School of Heraklion, Department of Radiology, University Hospital Heraklion, 71500 Heraklion-Stravrakia, Crete, Greece.
Cardiovasc Intervent Radiol. 2002 Jan-Feb;25(1):36-41. doi: 10.1007/s00270-001-0061-3. Epub 2002 Jan 18.
To assess the efficacy of percutaneous local thrombolysis with high-dose bolus recombinant tissue plasminogen activator (rt-PA) in patients with acute limb ischemia due to arterial thrombosis after cardiac catheterization.
We treated eight patients (7 men; mean age 56 years) with thrombotic occlusion of both the common femoral artery (CFA) and external iliac artery (EIA) in six patients and of the CFA only in two patients. Two 5 mg boluses of rt-PA were injected into the proximal clot through a 5 Fr end-hole catheter and subsequently two additional boluses of 5 mg rt-PA were given through a catheter with multiple side-holes. In case of a significant amount of residual thrombus, a continuous infusion of 2.5 mg/hr of rt-PA was started.
Successful lysis was achieved in all patients. The mean duration of lysis was 2 hr 41 min. The mean total amount of rt-PA delivered was 23.16 mg. In four patients unmasked flow-limited dissections confined to the CFA were managed by prolonged balloon dilatation, while in the remaining four patients with extension of the dissection to the external iliac artery one or two Easy Wallstents were implanted. There was prompt relief of lower limb ischemic symptoms and signs in all patients. Two groin hematomas were conservatively treated. Clinical and color Doppler flow imaging follow-up with a mean duration of 15 months, showed no reappearance of ischemic symptoms or development of restenosis in any of the patients. One patient died 6 months after thrombolysis.
Transcatheter thrombolysis with high-dose bolus rt-PA is a safe and effective treatment in patients with iatrogenic arterial occlusion after femoral catheterization. Underlying dissections should be treated by prolonged balloon dilatation but stent implantation is often required.
评估大剂量推注重组组织型纤溶酶原激活剂（rt-PA）经皮局部溶栓治疗心脏导管插入术后因动脉血栓形成导致急性肢体缺血患者的疗效。
我们治疗了8例患者（7例男性；平均年龄56岁），其中6例患者的股总动脉（CFA）和髂外动脉（EIA）均发生血栓闭塞，2例患者仅CFA发生血栓闭塞。通过一根5F端孔导管向近端血栓内注射两剂5mg的rt-PA，随后通过一根多侧孔导管再给予两剂5mg的rt-PA。如果存在大量残余血栓，则开始以2.5mg/小时的速度持续输注rt-PA。
所有患者均成功实现溶栓。平均溶栓持续时间为2小时41分钟。rt-PA的平均总给药量为23.16mg。4例仅局限于CFA的未掩盖的血流受限夹层通过延长球囊扩张进行处理，而其余4例夹层扩展至髂外动脉的患者植入了1个或2个易型Wallstent支架。所有患者的下肢缺血症状和体征均迅速缓解。2例腹股沟血肿采用保守治疗。平均为期15个月的临床和彩色多普勒血流成像随访显示，所有患者均未再次出现缺血症状或发生再狭窄。1例患者在溶栓后6个月死亡。
大剂量推注rt-PA经导管溶栓治疗股动脉插管后医源性动脉闭塞患者是一种安全有效的治疗方法。潜在的夹层应通过延长球囊扩张进行处理，但通常需要植入支架。
