title: Novel simultaneous combination chemical thrombolysis/rheolytic thrombectomy therapy for acute critical limb ischemia: the power-pulse spray technique.
abstract: 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.
authors.affiliation: Cardiovascular Institute of the South-Opelousas, 2730 Ambassador Caffery Parkway, Lafayette, LA 70506, USA. david.allie@cardio.com
authors.forename: David E
authors.initials: DE
authors.lastname: Allie
authors.forename: Chris J
authors.initials: CJ
authors.lastname: Hebert
authors.forename: Mitchell D
authors.initials: MD
authors.lastname: Lirtzman
authors.forename: Charles H
authors.initials: CH
authors.lastname: Wyatt
authors.forename: V Antoine
authors.initials: VA
authors.lastname: Keller
authors.forename: Mohamed H
authors.initials: MH
authors.lastname: Khan
authors.forename: Esmond A
authors.initials: EA
authors.lastname: Barker
authors.forename: Michael W
authors.initials: MW
authors.lastname: McElderry
authors.forename: Muhammad A
authors.initials: MA
authors.lastname: Khan
authors.forename: Peter S
authors.initials: PS
authors.lastname: Fail
authors.forename: Samuel J
authors.initials: SJ
authors.lastname: Stagg
authors.forename: Elena V
authors.initials: EV
authors.lastname: Mitran
authors.forename: Gary
authors.initials: G
authors.lastname: Chaisson
authors.forename: Sonja D
authors.initials: SD
authors.lastname: Allie
authors.forename: Adam A
authors.initials: AA
authors.lastname: Allie
authors.forename: Craig M
authors.initials: CM
authors.lastname: Walker
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D001157:Arterial Occlusive Diseases / Q000628:therapy; D003131:Combined Modality Therapy / Q000379:methods; D004305:Dose-Response Relationship, Drug; D005260:Female; D005268:Femoral Vein / Q000473:pathology / Q000601:surgery; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D005500:Follow-Up Studies; D006801:Humans; D007083:Iliac Artery / Q000473:pathology / Q000601:surgery; D007511:Ischemia / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy*; D035002:Lower Extremity / Q000098:blood supply* / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010960:Plasminogen Activators / Q000627:therapeutic use; D011150:Popliteal Artery / Q000473:pathology / Q000601:surgery; D012189:Retrospective Studies; D000077785:Tenecteplase; D017131:Thrombectomy / Q000379:methods; D015912:Thrombolytic Therapy / Q000379:methods; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D016896:Treatment Outcome; D014568:Urokinase-Type Plasminogen Activator / Q000627:therapeutic use
chemical_list: D005343:Fibrinolytic Agents; D010960:Plasminogen Activators; D010959:Tissue Plasminogen Activator; D014568:Urokinase-Type Plasminogen Activator; D000077785:Tenecteplase