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Novel simultaneous combination chemical thrombolysis/rheolytic thrombectomy therapy for acute critical limb ischemia: The power‐pulse spray technique
Author(s) -
Allie David E.,
Hebert Chris J.,
Lirtzman Mitchell D.,
Wyatt Charles H.,
Keller V. Antoine,
Khan Mohamed H.,
Barker Esmond A.,
McElderry Michael W.,
Khan Muhammad A.,
Fail Peter S.,
Stagg Samuel J.,
Mitran Elena V.,
Chaisson Gary,
Allie Sonja D.,
Allie Adam A.,
Walker Craig M.
Publication year - 2004
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.20216
Subject(s) - medicine , urokinase , thrombolysis , tenecteplase , saline , catheter , revascularization , surgery , occlusion , critical limb ischemia , anesthesia , myocardial infarction
The novel power‐pulse spray (P‐PS) technique maximizes and combines the advantages and minimizes the disadvantages of both chemical thrombolysis (CT) and rheolytic thrombectomy (RT). Forty‐nine consecutive patients with iliofemoral thrombotic occlusion were treated via P‐PS technique. Using a 6 Fr RT catheter, saline prime was exchanged for thrombolytic solution [group 1, 10–20 mg tenecteplase (TNK)/50 cc saline, n = 25; group 2, 1,000,000 urokinase (UK)/50 cc saline, n = 24]. The outflow port was closed, then the catheter was advanced at 1 mm increments while pulsing lytic agent. After 30‐min lysis time, RT and definitive treatment of the underlying stenosis were performed. Procedure success was 23/25 (92%) and 22/24 (91.6%) for group 1 and 2, respectively. The mean total procedure time was 72 and 75 min in group 1 and 2, respectively. Thirty‐day limb salvage was 91% in both groups. There were no major surgical complications. The P‐PS technique is safe and effective using either UK or TNK, offering several potential advantages over monotherapy, including more rapid revascularization, decreases systemic lytic exposure and bleeding complications while facilitating both CT and RT capacity and efficacy. Catheter Cardiovasc Interv 2004;63:512–522. © 2004 Wiley‐Liss, Inc.