Tsetis Dimitrios K, Katsamouris Asterios N, Giannoukas Athanasios D, Hatzidakis Adam A, Kostas Theodoros, Chamalakis Konstantinos, Ioannou Christos, Gourtsoyiannis Nicholas C
Department of Radiology, University Hospital of Heraklion, Medical School of Heraklion, Crete, Greece.
J Endovasc Ther. 2003 Aug;10(4):739-44. doi: 10.1177/152660280301000409.
To explore the potential benefits from heating recombinant tissue plasminogen activator (rtPA) before catheter-directed thrombolysis in patients with lower-limb ischemia of <30 days' duration.
Over a 2-year period, 34 patients (26 men; mean age 63.5 years, range 39-80) with 10 iliac and 24 infrainguinal arterial occlusions (5 embolic and 29 thrombotic) were treated with two 5-mg boluses of rtPA injected into the proximal clot, followed by 2 additional 5-mg boluses of rtPA. In the first 18 patients (group A), room temperature rtPA was administered, whereas in the last 16 patients (group B), the rtPA boluses were heated to 38 degrees C for 30 minutes before injection. Residual thrombus was treated with a continuous infusion of 2.5 mg/h of rtPA for 4 hours then at a reduced dose (1 mg/h).
Successful thrombolysis was achieved in 28 (82%) arteries. Unmasked lesions were treated with balloon angioplasty/stenting in 17 cases and with surgery in 4. One fatal retroperitoneal hematoma occurred in group A. Heating the rtPA did not significantly alter the outcome of thrombolysis. However, a statistically significant reduction in the total rtPA dose was observed in group B (24.28 mg versus 27.9 mg in group A, p=0.05), as well as quicker lysis (2 hours, 42 minutes versus 6 hours, 12 minutes in group A, p=0.001). There was no statistical difference in the amputation-free survival at 30 days between the groups.
In patients with acute or subacute lower limb ischemia treated with catheter-directed thrombolysis, heating the rtPA results in faster lysis with a considerable reduction in the total dose of the lytic agent.
探讨在病程小于30天的下肢缺血患者中，导管直接溶栓前加热重组组织型纤溶酶原激活剂（rtPA）的潜在益处。
在2年期间，对34例患者（26例男性；平均年龄63.5岁，范围39 - 80岁）进行治疗，这些患者有10例髂动脉和24例腹股沟下动脉闭塞（5例栓塞性和29例血栓性），将两次5mg剂量的rtPA注入近端血栓，随后再注入另外两次5mg剂量的rtPA。在最初的18例患者（A组）中，给予室温rtPA，而在最后的16例患者（B组）中，rtPA剂量在注射前加热至38摄氏度30分钟。残余血栓用2.5mg/h的rtPA持续输注4小时，然后以较低剂量（1mg/h）治疗。
28条（82%）动脉成功实现溶栓。17例未被发现的病变接受了球囊血管成形术/支架置入术治疗，4例接受了手术治疗。A组发生1例致命性腹膜后血肿。加热rtPA并未显著改变溶栓结果。然而，B组的rtPA总剂量有统计学显著降低（A组为27.9mg，B组为24.28mg，p = 0.05），并且溶栓速度更快（A组为6小时12分钟，B组为2小时42分钟，p = 0.001）。两组之间30天无截肢生存率无统计学差异。
在接受导管直接溶栓治疗的急性或亚急性下肢缺血患者中，加热rtPA可使溶栓速度更快，溶栓剂总剂量显著降低。
