[Intravascular ultrasound thrombolysis for recanalization of peripheral arteries: evaluation of an in vitro model and results of a pilot-study].
OBJECTIVE
To evaluate the effectiveness of ultrasound thrombolysis in vitro in comparison with thrombectomy, and in vivo as a pilot-study for the treatment of thrombotic occlusions of peripheral arteries.


METHODS
Under standardized conditions, one-day-old and five-day-old thrombi of whole blood, thrombin-induced thrombi and old organized thrombi of human blood were treated with ultrasound thrombolysis and Amplatz thrombectomy device (ATD). Four patients with arterial occlusive disease of Fontaine stage IIb-III underwent intraarterial ultrasound-thrombolysis, applied to long segmental occlusions of the superficial femoral or iliac artery ranging in duration from three days to one year.


RESULTS
The weight of the thrombi after ultrasound thrombolysis was 1.5 g +/- 0.53 (ATD: 0 g) compared to 3.65 g +/- 0.34 without treatment, with more weight reduction in five-day-old thrombi than in one-day-old thrombi. In vivo, partial recanalization was achieved in a three-day-old femoral occlusion. There was no effect in the other three patients. Urokinase thrombolysis with subsequent PTA and stenting resulted in complete recanalization in three patients.


CONCLUSIONS
Ultrasound thrombolysis in vitro was significantly less effective than ATD. The results of ultrasound thrombolysis were influenced by the age of the thrombus and its in vitro formation. Intravascular ultrasound thrombolysis alone was insufficient to treat occluded peripheral arteries in vivo.
Krüger
K
K
Institut und Poliklinik für Radiologische Diagnostik.
Deissler
P
P
Zähringer
M
M
Coburger
S
S
Gawenda
M
M
Lackner
K
K
D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D015901:Angiography, Digital Subtraction; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D005260:Female; D005263:Femoral Artery; D006801:Humans; D007083:Iliac Artery; D066298:In Vitro Techniques; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D010960:Plasminogen Activators / Q000008:administration & dosage / Q000627:therapeutic use; D015607:Stents; D017131:Thrombectomy; D015912:Thrombolytic Therapy; D013927:Thrombosis / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D013997:Time Factors; D014464:Ultrasonic Therapy; D014465:Ultrasonics; D018084:Ultrasonography, Interventional; D014568:Urokinase-Type Plasminogen Activator / Q000008:administration & dosage / Q000627:therapeutic use
D010960:Plasminogen Activators; D014568:Urokinase-Type Plasminogen Activator