Pharmacomechanical thrombolysis of experimental pulmonary emboli. Rapid low-dose intraembolic therapy.
We utilized low-dose intraembolic urokinase (UK) infusions in a canine model of experimental pulmonary embolism (PE) and compared the arteriographic extent of thrombolysis with three other treatment regimens. Group 1 animals (n = 16) received the intraembolic UK infused directly into the PE offering the mechanical effect of the infusion combined with pharmacologic thrombolysis. In the group 2 animals (n = 5), UK was delivered via a guide catheter placed proximal to the clot. Group 3 animals (n = 6) were treated with a direct intraembolic saline solution infusion. Group 4 (n = 7) received only intravenous heparin. The arteriographic extent of thrombolysis was graded 1+ to 3+. The extent of thrombolysis was 2.88+ in the group 1 animals and was significantly greater than in groups 2, 3, or 4 (p = 0.003, 0.0005, and 0.0001, respectively). Fibrinogen levels did not significantly decrease with intraembolic treatment (p = 0.07). Delivery of UK directly into emboli in an experimental canine PE model appears to elicit a combined mechanical and pharmacologic effect resulting in extensive thrombolysis.
Tapson
V F
VF
Division of Pulmonary and Critical Care, Duke University Medical Center, Durham, NC 27710.
Gurbel
P A
PA
Witty
L A
LA
Pieper
K S
KS
Stack
R S
RS
D000818:Animals; D002406:Catheterization, Peripheral / Q000295:instrumentation; D004195:Disease Models, Animal; D004285:Dogs; D004353:Drug Evaluation, Preclinical; D005340:Fibrinogen / Q000032:analysis / Q000187:drug effects; D006493:Heparin / Q000008:administration & dosage; D007261:Infusions, Intra-Arterial / Q000295:instrumentation; D011651:Pulmonary Artery / Q000000981:diagnostic imaging; D011655:Pulmonary Embolism / Q000097:blood / Q000000981:diagnostic imaging / Q000188:drug therapy*; D011859:Radiography; D011897:Random Allocation; D015912:Thrombolytic Therapy / Q000295:instrumentation / Q000379:methods*; D014568:Urokinase-Type Plasminogen Activator / Q000008:administration & dosage*
D005340:Fibrinogen; D006493:Heparin; D014568:Urokinase-Type Plasminogen Activator