Lim G M, Bookstein J J
Division of Vascular & Interventional Radiology, University of California San Diego, 92103, USA.
J Vasc Interv Radiol. 1998 Jul-Aug;9(4):618-25. doi: 10.1016/s1051-0443(98)70332-x.
This study was designed to evaluate the efficacy of plasminogen enrichment of subacute thrombus in further accelerating pulse-spray pharmacomechanical thrombolysis (PSPMT) with urokinase (UK) or tissue plasminogen activator (tPA) in a rabbit model.
With use of a subacute rabbit inferior vena cava (IVC) thrombosis model, 78 rabbits were divided into eight groups according to the agents used for thrombolysis: (i) controls (IVC thrombosis, no lysis performed), (ii) pulse-spray thrombolysis with saline only, (iii) PSPMT with UK, (iv) PSPMT with UK, plus interim pulse-spray plasminogen enrichment after 14 minutes, (v) pulse-spray plasminogen enrichment, followed at 10 minutes by PSPMT with UK, (vi) PSPMT with tPA, (vii) PSPMT with tPA, plus interim plasminogen enrichment, and (viii) pulse-spray plasminogen enrichment, followed at 10 minutes by PSPMT with tPA.
Intrathrombic pulsed injection of glu-plasminogen after 14 minutes of tPA PSPMT demonstrated significant augmentation of lysis (approximately 31% decrease in residual thrombus) compared with tPA alone (P = .006). Lysis was not augmented significantly when plasminogen was sprayed into thrombus before tPA, or before or after UK.
Plasminogen enrichment of thrombus after onset of PSPMT with tPA significantly accelerated thrombolysis in a subacute in vivo rabbit model. A clinical trial of this method may be warranted.
本研究旨在评估在兔模型中，亚急性血栓富含纤溶酶原对进一步加速尿激酶（UK）或组织型纤溶酶原激活剂（tPA）脉冲喷射药物机械性溶栓（PSPMT）的疗效。
利用亚急性兔下腔静脉（IVC）血栓形成模型，根据溶栓所用药物将78只兔分为八组：（i）对照组（IVC血栓形成，未进行溶栓），（ii）仅用生理盐水脉冲喷射溶栓，（iii）用UK进行PSPMT，（iv）用UK进行PSPMT，在14分钟后进行中期脉冲喷射纤溶酶原富集，（v）脉冲喷射纤溶酶原富集，10分钟后用UK进行PSPMT，（vi）用tPA进行PSPMT，（vii）用tPA进行PSPMT，加中期纤溶酶原富集，（viii）脉冲喷射纤溶酶原富集，10分钟后用tPA进行PSPMT。
与单独使用tPA相比，在tPA进行PSPMT 14分钟后向血栓内脉冲注射谷氨酰胺纤溶酶原显示溶栓显著增强（残余血栓减少约31%）（P = 0.006）。在tPA之前、UK之前或之后将纤溶酶原喷入血栓时，溶栓未显著增强。
在亚急性体内兔模型中，tPA启动PSPMT后血栓富含纤溶酶原可显著加速溶栓。可能有必要对该方法进行临床试验。
