Wissgott C, Kamusella P, Richter A, Klein-Weigel P, Schink T, Steinkamp H J
Radiologie, DRK-Kliniken Berlin, Berlin.
Rofo. 2008 Jun;180(6):547-52. doi: 10.1055/s-2008-1027216. Epub 2008 May 16.
Mechanical thrombectomy has become a viable alternative to intra-arterial thrombolysis for the treatment of acute infrainguinal occlusion. The aim of this prospective study was to evaluate the safety and effectiveness of a mechanical thrombectomy system in comparison with ultrasound-enhanced thrombolysis.
From April 2005 to March 2007, 20 patients, mean age 67.4+/-13.6, with acute occlusions of the femoropopliteal bypass graft were treated with either a rotational thrombectomy system (Straub Rotarex, n=10) or with 1.0 mg/h Actilyse using an ultrasound-enhanced lysis system (EKOS Lysus Peripheral Catheter System, n=10). The mean occlusion length was 33.1 cm (range 28-40 cm) in the thrombectomy group and 33.7 cm (11-50 cm) in the lysis group.
The technical success rate was 100% in the thrombectomy group and 90 % in the lysis group. The mean treatment time was significantly lower with 64.5 min (45-90 min) in the thrombectomy group in comparison with 904.0 min (120-1350 min) in the lysis group. The ankle brachial index (ABI) improved in the thrombectomy group from 0.41+/-0.09 to 0.86+/-0.10 at discharge and 0.85+/-0.07 after 1 month (p<0.05) and in the lysis group from preinterventional 0.37+/-0.15 to 0.82+/-0.16 at discharge and 0.80+/-0.24 after 1 month (p<0.05). In one case lysis had to be stopped after two hours because of dislocation of the introducer sheath which was then treated by open surgery.
Mechanical-rotational thrombectomy with the Rotarex system and lysis with the ultrasound-enhanced catheter from Ekos were very safe and effective treatment options for acute occlusion. Blood flow is restored much faster with mechanical thrombectomy.
机械血栓切除术已成为治疗急性股腘动脉闭塞的动脉内溶栓的可行替代方法。这项前瞻性研究的目的是评估一种机械血栓切除系统与超声增强溶栓相比的安全性和有效性。
2005年4月至2007年3月，20例平均年龄67.4±13.6岁的股腘动脉搭桥移植急性闭塞患者，分别采用旋转血栓切除系统（Straub Rotarex，n = 10）或使用超声增强溶栓系统（EKOS Lysus外周导管系统，n = 10）以1.0mg/h的剂量使用阿替普酶进行治疗。血栓切除组的平均闭塞长度为33.1cm（范围28 - 40cm），溶栓组为33.7cm（11 - 50cm）。
血栓切除组的技术成功率为100%，溶栓组为90%。血栓切除组的平均治疗时间显著低于溶栓组，分别为64.5分钟（45 - 90分钟）和904.0分钟（120 - 1350分钟）。血栓切除组出院时踝肱指数（ABI）从0.41±0.09改善至0.86±0.10，1个月后为0.85±0.07（p < 0.05）；溶栓组介入前为0.37±0.15，出院时为0.82±0.16，1个月后为0.80±0.24（p < 0.05）。1例患者因引导鞘管移位，两小时后停止溶栓，随后接受开放手术治疗。
使用Rotarex系统进行机械旋转血栓切除术以及使用Ekos的超声增强导管进行溶栓是治疗急性闭塞非常安全有效的选择。机械血栓切除术能更快恢复血流。
