Kandarpa K, Drinker P A, Singer S J, Caramore D
Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115.
Radiology. 1988 Sep;168(3):739-44. doi: 10.1148/radiology.168.3.3406403.
Forceful local pulsatile infusion of fibrinolytic enzyme disrupts thrombi, increases clot surface area, and thereby hastens enzyme action compared with conventional constant infusion methods, which are time consuming and therefore expensive. Prolonged thrombolytic therapy is associated with increased patient morbidity. A prototype for a clinically applicable pulsatile jet infusion system for accelerating thrombolysis was designed. The system is adaptable to standard angiographic catheters and techniques. The core of the system is a reciprocating syringe pump that delivers small volumes of thrombolytic enzyme in short, rapid, frequent pulses at high exit-jet velocity through any side-hole catheter (the smallest used was a 3-F catheter). Comparison of this system with a constant infusion system was made in vivo in a 48-hour-old thrombus model in rabbit inferior vena cava (IVC). One hour of lysis by streptokinase was conducted with each of the methods. In the first experiment, the IVC thrombi were left intact before chemical lysis. Pulsatile infusion lysed 61% of the thrombus by weight in an hour, whereas constant infusion lysed only 15% (P less than .001). In the second experiment, IVC thrombi were subjected initially to standardized mechanical perturbation by a guide wire before chemical lysis. In the latter experiment, pulsatile infusion lysed 54% of the thrombus by weight, and constant infusion lysed only 26% (P less than .005). The difference in percentage of lysis by weight between pulsatile infusion groups in the two experiments (61% vs 54%) was not significant (P greater than .1). The same was true of the difference between the two constant infusion groups (26% vs 15%, P greater than .05). The effect of initial perturbation of the thrombus by a guide wire appears to be less important than the thrombus disruption and accelerated thrombolysis caused by the pulsatile delivery system. No angiographic or macroscopically visible damage was seen in any IVC. Accelerated thrombolysis may reduce the expense, duration, and morbidity associated with conventional constant infusion methods.
与传统的持续输注方法相比，强力局部脉动输注纤溶酶可破坏血栓、增加血栓表面积，从而加快酶的作用，传统方法耗时且昂贵。延长溶栓治疗会增加患者的发病率。设计了一种用于加速溶栓的临床适用脉动喷射输注系统的原型。该系统适用于标准血管造影导管和技术。该系统的核心是一个往复式注射泵，它通过任何侧孔导管（使用的最小导管为3F导管）以高出口喷射速度在短时间内、快速、频繁地脉冲输送少量溶栓酶。在兔下腔静脉（IVC）48小时血栓模型中对该系统与持续输注系统进行了体内比较。每种方法均用链激酶进行1小时的溶栓。在第一个实验中，化学溶栓前IVC血栓保持完整。脉动输注在1小时内溶解了61%的血栓重量，而持续输注仅溶解了15%（P小于0.001）。在第二个实验中，化学溶栓前先用导丝对IVC血栓进行标准化机械扰动。在后者实验中，脉动输注溶解了54%的血栓重量，而持续输注仅溶解了26%（P小于0.005）。两个实验中脉动输注组之间按重量计的溶解百分比差异（61%对54%）不显著（P大于0.1）。两个持续输注组之间的差异（26%对15%，P大于0.05）也是如此。导丝对血栓的初始扰动作用似乎不如脉动输送系统引起的血栓破坏和加速溶栓重要。在任何IVC中均未观察到血管造影或肉眼可见的损伤。加速溶栓可能会降低与传统持续输注方法相关的费用、持续时间和发病率。
