Hansen D D, Auth D C, Vracko R, Ritchie J L
Division of Cardiology, Seattle Veterans Administration Hospital, University of Washington.
Int J Cardiol. 1989 Jan;22(1):13-9. doi: 10.1016/0167-5273(89)90130-7.
We have developed a mechanical thrombolytic catheter which defibrinates a fresh intra-arterial thrombus by wrapping fibrin about its rotating shaft. Defibrination results in liquification of the thrombus and reperfusion of the thrombotically occluded vessel. In this study, we employed this catheter-based approach in dogs with coronary thrombosis to simulate possible clinical use in acute myocardial infarction. Total coronary thrombosis was generated in 11 dogs. Spontaneous reperfusion did not occur over a 30-minute control period. All vessels studied were initially totally thrombosed. After mechanical thrombolysis, there was a significant improvement in percent diameter stenosis from 100% to 28 +/- 26% (P less than 0.001). After thrombolysis, angiographically graded blood flow was normal in 9 of 11 arteries and was mildly delayed in 2 of 11. Complications included perforation of 2 vessels. We conclude that mechanical thrombolysis, with a rotating catheter, results in prompt reperfusion of the infarct vessel and significant improvement in distal blood flow. This approach, unlike angioplasty, removes the thrombus and might serve as an alternative to or supplemental form of mechanical thrombolysis.
我们研发了一种机械溶栓导管，它通过将纤维蛋白缠绕在其旋转轴上使新鲜的动脉内血栓去纤维蛋白化。去纤维蛋白化导致血栓液化以及血栓闭塞血管的再灌注。在本研究中，我们在患有冠状动脉血栓形成的犬中采用这种基于导管的方法来模拟急性心肌梗死可能的临床应用。在11只犬中造成了完全性冠状动脉血栓形成。在30分钟的对照期内未发生自发再灌注。所有研究的血管最初均完全血栓形成。机械溶栓后，直径狭窄百分比从100%显著改善至28±26%（P＜0.001）。溶栓后，11条动脉中有9条动脉的血管造影分级血流正常，11条中有2条轻度延迟。并发症包括2条血管穿孔。我们得出结论，使用旋转导管进行机械溶栓可使梗死血管迅速再灌注，并使远端血流显著改善。与血管成形术不同，这种方法可清除血栓，可能作为机械溶栓的替代方法或补充形式。
