ThrombolysisThrombolysis

What is it?What is it?

A Procedure that removes or A Procedure that removes or destroys clotsdestroys clots

Preformed in a Angio suitPreformed in a Angio suit Many times both a Radiologist and a Many times both a Radiologist and a

Vascular surgeonVascular surgeon Most common reason for during Most common reason for during

procedure is {peripheral Arterial procedure is {peripheral Arterial Occlusive DiseaseOcclusive Disease

TechniquesTechniques

Introduction of catheter into the Introduction of catheter into the Femoral ArteryFemoral Artery

Catheter Advanced to the clot siteCatheter Advanced to the clot site Different Drugs are administered to Different Drugs are administered to

the sitethe site Streptokinase, Urokinase, or rtPAStreptokinase, Urokinase, or rtPA

TechniquesTechniques

Catheter placement in Femoral ArteryCatheter placement in Femoral Artery

TechniquesTechniques

Local Low Dose ThrombolysisLocal Low Dose Thrombolysis Discovered by Dotter in 1974Discovered by Dotter in 1974 Less hazardous treatmentLess hazardous treatment More efficient More efficient Pharmaceutical - StreptokinasePharmaceutical - Streptokinase

TechniquesTechniquesLocal Low-DoseLocal Low-Dose

Unlike other techniques at the time Unlike other techniques at the time the dose is reduced to 1/20 the sizethe dose is reduced to 1/20 the size

Very popular in treating ilio-femoral Very popular in treating ilio-femoral ThrombosusesThrombosuses

TechniquesTechniquesLocal Low-DoseLocal Low-Dose

AdvantagesAdvantages Pure drug right to thrombusPure drug right to thrombus Protection of lytic agents from Protection of lytic agents from

antibodies and inhibitorsantibodies and inhibitors Loading dose not necessaryLoading dose not necessary Shorter infusion timeShorter infusion time Less costlyLess costly

TechniquesTechniquesLocal Low-DoseLocal Low-Dose

TechniquesTechniquesUrokinase InfusionUrokinase Infusion

This technique is most used for patients This technique is most used for patients with low risk of tissue infarctionwith low risk of tissue infarction

Catheter is placed in the affected arteryCatheter is placed in the affected artery Tip is placed 5 to 10mm from clot siteTip is placed 5 to 10mm from clot site Urokinase is infused at a rate of 60 ml/hrUrokinase is infused at a rate of 60 ml/hr Patient is brought back to department Patient is brought back to department

every 4 to 8 hours to check Clot Lysisevery 4 to 8 hours to check Clot Lysis

TechniquesTechniquesMcNamara InfusionMcNamara Infusion

The procedure again uses the The procedure again uses the placement of catheters to the clot siteplacement of catheters to the clot site

This procedure is specially used for This procedure is specially used for patients at high risk for Limb or Organ patients at high risk for Limb or Organ loselose

Much like the Low-Dose technique Much like the Low-Dose technique but, infusion rate is quadrupled for but, infusion rate is quadrupled for first 6 hoursfirst 6 hours

TechniquesTechniquesMcNamara InfusionMcNamara Infusion

Once clot shows signs of dissolving Once clot shows signs of dissolving then rate is slowed to that of the then rate is slowed to that of the Low-Dose techniqueLow-Dose technique

If clot does not show any signs of If clot does not show any signs of breaking down the patients will often breaking down the patients will often be sent to surgery to have organ or be sent to surgery to have organ or limb removedlimb removed

TechniquesTechniquesHessHess

Catheter is advanced to the clot siteCatheter is advanced to the clot site Either Streptokinase or Urokinase Either Streptokinase or Urokinase

can be usedcan be used A hand injected method is usedA hand injected method is used 1 to 3 ml is given every 5 minutes1 to 3 ml is given every 5 minutes

TechniquesTechniquesHessHess

AdvantagesAdvantages Operator is able to view clot breaking Operator is able to view clot breaking

down under fluoroscopy, chase clot down under fluoroscopy, chase clot as it movesas it moves

Operator has full control of when Operator has full control of when drug is administereddrug is administered

Shorter procedureShorter procedure