Rapid thrombectomy with a hydrodynamic catheter: results from a prospective, multicenter trial.
OBJECTIVE
To evaluate efficacy and safety of a hydrodynamic rheolytic thrombectomy device for rapid percutaneous treatment of acute thromboembolic occlusions of native lower-extremity arteries and bypass grafts.


METHODS
In 50 patients, thrombectomy was performed with the rheolytic catheter at four centers. Patients had acute occlusions of native lower-extremity arteries (n = 39) or acute thrombosis of lower-limb bypass grafts (n = 11). Estimated occlusion age was 5 days +/- 5. Mean thrombus length was 15 cm +/- 11. Clinical success was measured on a scale of -3 (deterioration) to +3 (improvement) with established criteria.


RESULTS
With the thrombectomy catheter, the majority of thrombus material was removed and antegrade blood flow was reestablished in 45 (90%) patients. Technical success (residual luminal narrowing < 50%) was 52% with use of the device alone. Adjunctive therapy was performed in 45 patients. Clinical improvement after intervention was +3 in 25 (50%) patients, +2 in 10 (20%), +1 in six (12%), and 0 (no improvement) in nine (18%). Clinically unimportant complications related to use of the device were one (2%) distal embolization and two (4%) dissections. Laboratory analysis revealed hemolysis without clinical sequelae. Primary patency rates were 76% after 30 days, 74% after 3 months, and 69% after 1 year.


CONCLUSIONS
The hydrodynamic catheter appears to be safe and effective for rapid thrombectomy.
Wagner
H J
HJ
Department of Diagnostic Radiology, University Hospital, Philipps University, Marburg, Germany.
Müller-Hülsbeck
S
S
Pitton
M B
MB
Weiss
W
W
Wess
M
M
D000368:Aged; D002404:Catheterization / Q000295:instrumentation; D004867:Equipment Design; D005240:Feasibility Studies; D005260:Female; D006083:Graft Occlusion, Vascular / Q000601:surgery*; D006801:Humans; D007866:Leg / Q000098:blood supply; D008297:Male; D011446:Prospective Studies; D012039:Regional Blood Flow; D017131:Thrombectomy / Q000295:instrumentation*; D013927:Thrombosis / Q000601:surgery*; D013997:Time Factors