[Simple and effective rt-PA thrombolysis design].
OBJECTIVE
Assessment of a novel, simple and practical thrombolysis scheme for the purposes of a central hospital.


METHODS
314 thromboembolic lower extremity occlusions in 260 consecutive patients were treated by thrombolysis as follows: 6 ml rt-PA/h for 30 min; 3 ml rt-PA/h for another 30 min; 1 ml rt-PA/h for 7 hours, and 0.4 ml rt-PA until vessel patency. Antegrade introduction of a 5 F straight end-hole catheter through a 6 F, constantly heparin-flushed sheath, to the level of occlusion was followed by subsequent advancement of the catheter tip according to progress of lysis at time intervals of 2, 4, and 8 hours. The regimen was continued overnight.


RESULTS
82% of arterial occlusions were completely recanalized at the end of thrombolysis. Then, angioplasty was performed if appropriate. Best results (100% recanalization rate) were achieved by treating occlusions of the superficial femoral artery, even in cases of involvement of the entire length of the vessel, and isolated popliteal occlusions. A recanalization rate of 70% was achieved by treating distal crural vessel occlusion. Bypass grafts were recanalized in 50%.


RESULTS
3 x major hematoma, 2 x transluminal perforation; 16 x minor hematoma from the puncture site at the sheath, 4 x erythema, obviously reaction to rt-PA (together n = 25; 8%).


CONCLUSIONS
We empirically found and solidly evaluated an effective thrombolysis scheme. Our results demonstrate that major advances are possible even in this well-grounded field.
Cejna
M
M
Ludwig-Boltzmann-Institut für Interventionelle Magnetresonanz, A. ö. Krankenhaus der Landeshauptstadt St. Pölten.
Salomonowitz
E
E
Wohlschlager
H
H
Zwrtek
K
K
Böck
R
R
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017130:Angioplasty; D001157:Arterial Occlusive Diseases / Q000188:drug therapy* / Q000601:surgery; D002404:Catheterization / Q000009:adverse effects / Q000379:methods; D004890:Erythema / Q000209:etiology; D005260:Female; D005263:Femoral Artery; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D006406:Hematoma / Q000209:etiology; D006801:Humans; D007261:Infusions, Intra-Arterial; D008297:Male; D008875:Middle Aged; D011150:Popliteal Artery; D011994:Recombinant Proteins / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D012189:Retrospective Studies; D015912:Thrombolytic Therapy / Q000379:methods; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*
D005343:Fibrinolytic Agents; D011994:Recombinant Proteins; D010959:Tissue Plasminogen Activator
Einfaches und effektives rt-PA Thrombolyse-Design.