A patient with severe hand ischemia due to Buerger's disease was treated by a rapidly effective modification of percutaneous catheterization. Accelerated mechanical and pharmacologic thrombolysis of an occluded palmar arch with 200,000 U urokinase and subsequent small vessel angioplasty abolished pain and restored digital perfusion within 40 min.

Angioplasty, Balloon↗

PubMedDate not supplied

Pulse-spray pharmacomechanical thrombolysis.

The synergistic potential of combining pharmacologic and mechanical methods of thrombolysis has recently been recognized. Pulse-spray pharmacomechanical thrombolysis is one such method, which in our experience has markedly increased the efficiency and acceptability of thrombolysis. With this technique, dialysis grafts usually require only 20-35 min for thrombolysis; bypass grafts or native arteries usually require 60-150 min. The entire procedure is accomplished in one session within the angiography suite, including the supplemental transluminal angioplasty, atherectomy, or stenting that is usually also necessary. Clear understanding of the principle of the method and meticulous attention to technical details is essential for maximal speed, safety, and efficacy.

Adolescent↗

PubMedDate not supplied

Plasminogen-enriched pulse-spray thrombolysis with tPA: further developments.

PURPOSE: To further improve methods for pulsed plasminogen-enriched thrombolysis and to compare results with the best obtainable with use of tissue plasminogen activator (tPA) alone. MATERIALS AND METHODS: Parameters of plasminogen-enriched pulse-spray thrombolysis were manipulated in groups of rabbits with inferior vena cava thrombosis, and weights of 1-hour residual thrombus were compared. Variables evaluated were (i) tPA pulse frequency, (ii) amount of plasminogen used for enrichment, (iii) tPA concentration and amount, (iv) pulsed versus infused tPA, and (v) admixture versus separation of plasminogen and tPA. RESULTS: With use of 3 mg of tPA and approximately 0.9 mg plasminogen enrichment, efficacy varied directly with pulse frequency over a pulse range of every 15 minutes to every 30 seconds. With use of 30-second pulses of tPA at a concentration 0.125 mg/mL, efficacy also correlated directly with increasing plasminogen enrichment up to, but not beyond, approximately 1.8 mg per 1.24 g of clot. Optimized methodology yielded 89% lysis in 1 hour, as compared to 74% lysis previously reported with use of optimized low-concentration (0.01 mg/ mL) tPA alone. Plasminogen enrichment in conjunction with low concentrations of tPA, admixture of tPA and plasminogen, and fractionation of the plasminogen enrichment all proved to be nonproductive or counterproductive. CONCLUSION: Optimized in vivo postthrombotic plasminogen enrichment significantly accelerated thrombolysis of experimental clots compared to use of optimized tPA alone.

Animals↗