Müller-Hülsbeck S, Schwarzenberg H, Link J, Walluscheck K, Brossmann J, Regensburger D, Heller M
Klinik für Radiologische Diagnostik, Christian-Albrechts-Universität zu Kiel.
Rofo. 1996 Dec;165(6):557-62. doi: 10.1055/s-2007-1015811.
The evaluation of local rt-PA pulse-spray-lysis (PSL) by the Katzen infusion wire for treatment of thrombosed leg arteries and bypass grafts.
21 patients (mean age 64.4 years) with either occluded leg arteries (n = 19) or femorocrural bypass grafts (n = 2) were treated with PSL. Mean length of occlusion was 13.2 +/- 11.6 cm. Time of occlusion ranged from less than one week to 6 months.
In 71.43% (15/21) the occlusions could be successfully recanalized with PSL. The mean rt-PA dose was 10.7 +/- 4.9 mg. Remaining stenoses were handled with PTA (n = 9) and additional stent implantation (n = 3). Additional long-time-lysis with 17.5 mg rt-PA was necessary in two cases, the success rate increased to 81% (17/21). The anlde-brachial-index increased from 0.38 +/- 0.29 to 0.83 +/- 0.32 within 24 hours after intervention. In 4 cases bleeding complications occurred. 5 patients showed reocclusions during 6 months follow-up.
Local fibrinolysis with rt-PA in PSL technique using the Katzen infusion wire is a feasible and promising treatment of thrombosed leg arteries and grafts. Even careful and dosage-minimized rt-PA application cannot prevent bleeding complications.
评估使用卡曾灌注导丝进行局部rt-PA脉冲喷雾溶栓（PSL）治疗下肢动脉血栓形成和旁路移植血管的效果。
21例患者（平均年龄64.4岁），其中下肢动脉闭塞患者19例，股腘旁路移植血管患者2例，接受了PSL治疗。平均闭塞长度为13.2±11.6厘米。闭塞时间从不到一周到6个月不等。
71.43%（15/21）的闭塞病变可通过PSL成功再通。rt-PA平均剂量为10.7±4.9毫克。残余狭窄采用经皮腔内血管成形术（PTA，9例）和额外的支架植入术（3例）处理。2例患者需要额外使用17.5毫克rt-PA进行长时间溶栓，成功率提高到81%（17/21）。干预后24小时内，踝臂指数从0.38±0.29提高到0.83±0.32。4例出现出血并发症。5例患者在6个月随访期间出现再闭塞。
使用卡曾灌注导丝的PSL技术中，采用rt-PA进行局部溶栓是治疗下肢动脉和移植血管血栓形成的一种可行且有前景的方法。即使谨慎并尽量减少rt-PA用量，也无法预防出血并发症。
