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Fan W, Lu S, Tan J, Cui X, Liang K, Zhu L, He Q, Yu B, Shi W. Midterm Results of Drug-Coated Balloon Alone or Combined with Rotarex Thrombectomy Device for Treatment of Subacute Femoropopliteal Artery Thrombotic Occlusion. Ann Vasc Surg 2022; 92:240-248. [PMID: 36503024 DOI: 10.1016/j.avsg.2022.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 10/23/2022] [Accepted: 11/15/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND This retrospective multicenter study aimed to compare the midterm results of the Rotarex rotational thrombectomy device combined with drug-coated balloon (DCB) and DCB-alone for the treatment of subacute femoropopliteal artery thrombotic occlusion. METHODS All patients (74, aged 70.1 ± 9.3 years) were nonrandomized and divided into 2 groups based on treatment strategy between 2018 and 2020. Intraoperative technical success (defined as <30% residual stenosis), dissection types and bailout-stenting rates were assessed. Ankle-brachial index (ABI), primary patency (PP, restenosis <50%) and freedom from clinically driven target lesion reintervention (CD-TLR) were documented at follow-up. RESULTS Among them, 35 patients were treated with the Rotarex catheter combined with DCB while 39 patients underwent DCB-alone. The-overall technical success rate was 100%. Patients in the Rotarex + DCB group showed lower rate of bailout stenting than those in the DCB alone group (22.9% vs. 59.0%; P = 0.01). ABI at discharge was significantly higher in both groups. Mean follow-up time was 18.5 ± 3.4 months; 62 patients completed Doppler ultrasound investigation while 12 patients were censored. According to Kaplan-Meier analysis, the estimated PP was 82.0 ± 6.7% in the Rotarex + DCB group, whereas a significantly lower rate in the DCB alone group (60.9 ± 8.3%, P = 0.04). In addition, the freedom from CD-TLR rate was 82.9 ± 6.4% in the Rotarex + DCB group and 61.5 ± 7.8% in the DCB-alone group (P = 0.04). CONCLUSIONS These initial data indicate that the Rotarex thrombectomy device combined with DCB is an effective choice for the treatment of subacute femoropopliteal artery thrombotic occlusion compared to DCB-alone. The combined procedure had superior midterm results.
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Affiliation(s)
- Weijian Fan
- Department of Vascular Surgery, Huashan Hospital of Fudan University, Shanghai, PR China; Department of Vascular Surgery, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, PR China
| | - Shuangshuang Lu
- Department of Radiology, Huashan Hospital of Fudan University, Shanghai, PR China
| | - Jinyun Tan
- Department of Vascular Surgery, Huashan Hospital of Fudan University, Shanghai, PR China; Fudan Zhangjiang Institute, Shanghai, PR China
| | | | - Kun Liang
- Department of Vascular Surgery, Huashan Hospital of Fudan University, Shanghai, PR China
| | - Lei Zhu
- Department of Vascular Surgery, Huashan Hospital of Fudan University, Shanghai, PR China
| | - Qing He
- Department of Vascular Surgery, Huashan Hospital of Fudan University, Shanghai, PR China
| | - Bo Yu
- Department of Vascular Surgery, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, PR China; Fudan Zhangjiang Institute, Shanghai, PR China.
| | - Weihao Shi
- Department of Vascular Surgery, Huashan Hospital of Fudan University, Shanghai, PR China.
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Wang CC, Lu CR, Hsieh LC, Kuo CC, Huang PW, Chang KC, Chang CT, Hsu CH. Comparison of pharmaco-mechanical thrombolysis and catheter-directed thrombolysis for treating thrombotic or embolic arterial occlusion of the lower limb. INT ANGIOL 2022; 41:292-302. [PMID: 35437980 DOI: 10.23736/s0392-9590.22.04809-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Whether pharmaco-mechanical thrombolysis (PMT) results in superior outcomes to catheter-directed thrombolysis (CDT) in treating thrombotic or embolic arterial occlusion of the lower limbs is unclear. METHODS We enrolled 94 patients with Rutherford class I-IIb due to thrombotic or embolic arterial occlusion in the lower limbs and who received emergency endovascular treatment. Baseline demographics, laboratory data, angiography and clinical outcomes were collected through chart reviews and fluoroscopic imaging. The procedural characteristics (thrombolytic drug dosage, treatment duration, and additional procedures), immediate angiographic outcomes (patency of calf vessels, and complete lysis), complications (major bleeding, and fasciotomy), and primary composite end-points (30-day mortality, amputation, and reocclusion) were compared between patients who received CDT versus PMT. RESULTS Compared with CDT, PMT was independently associated with lower total UK dosage (standardised coefficientβ= - 0.44; p < 0.01) and higher prevalence of complete lysis (odds ratio = 1.78, 95% confidence interval: 1.03 - 3.06; p = 0.04) after adjustments of covariates. The PMT group had significantly shorter treatment duration (23.00 [7.25 - 39.13] vs. 41.00 [27.00 - 52.50]; p < 0.01). No significant intergroup differences were observed for the primary composite end point (10.7% vs. 9.1%; p = 0.81), or prevalence of the major bleeding (9.1% vs. 0.0%; p = 0.10) despite the PMT group comprising patients with more.advanced chronic kidney disease and more diffuse thrombosis. CONCLUSIONS PMT with a Rotarex is a safe and effective strategy for treating thrombotic or embolic lower limb ischemia. It significantly reduced the thrombolytic drug dosage, and resulted in the complete lysis being more likely.
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Affiliation(s)
- Chun-Cheng Wang
- School of Medicine, China Medical University, Thaicung, Taiwan.,Division of Cardiovascular Medicine, Department of Internal Medicine, China Medical University Hospital, Thaicung, Taiwan
| | - Chiung-Ray Lu
- Division of Cardiovascular Medicine, Department of Internal Medicine, China Medical University Hospital, Thaicung, Taiwan
| | - Li-Chuan Hsieh
- Division of Cardiovascular Medicine, Department of Internal Medicine, China Medical University Hospital, Thaicung, Taiwan
| | - Chin-Chi Kuo
- School of Medicine, China Medical University, Thaicung, Taiwan.,Big Data Center, China Medical University Hospital, Thaicung, Taiwan.,Division of Nephrology, Department of Internal Medicine, China Medical University Hospital, Thaicung, Taiwan.,Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
| | - Pei-Wen Huang
- Big Data Center, China Medical University Hospital, Thaicung, Taiwan.,Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
| | - Kuan-Cheng Chang
- School of Medicine, China Medical University, Thaicung, Taiwan.,Division of Cardiovascular Medicine, Department of Internal Medicine, China Medical University Hospital, Thaicung, Taiwan
| | - Chiz-Tzung Chang
- School of Medicine, China Medical University, Thaicung, Taiwan.,Division of Nephrology, Department of Internal Medicine, China Medical University Hospital, Thaicung, Taiwan
| | - Chung-Ho Hsu
- Division of Cardiovascular Medicine, Department of Internal Medicine, China Medical University Hospital, Thaicung, Taiwan -
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Liu J, Li T, Huang W, Zhao N, Liu H, Zhao H, Xu J, Wang H. Drug-coated balloons used in peripheral artery disease: experience from a single center. J Int Med Res 2021; 48:300060520940157. [PMID: 32762385 PMCID: PMC7416143 DOI: 10.1177/0300060520940157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE This retrospective single-center study aimed to analyze immediate and follow-up results of using drug-coated balloons (DCBs) for treating peripheral arterial disease. METHODS In this study, we identified a total of 75 patients who underwent DCB therapy at our institution. The ankle-brachial index (ABI) was measured before and after intervention. Intermittent claudication and whether there was healing of ulcers were determined by telephone. RESULTS The cohort consisted of 56 men and 19 women aged 38 to 87 years (68 ± 12 years). Twenty-three patients had Rutherford grade III, 15 had Rutherford grade IV, and 37 had Rutherford grade V. Seventeen patients had stents and 18 had the Rotarex system used. The postoperative ABI was significantly greater than the preoperative ABI (0.911 ± 0.173 vs 0.686 ± 0.249). Good results for treatment were obtained. Intermittent claudication and rest pain did not occur in subjects with Rutherford grades III and IV during follow-up. The amputation rate was 4.1% among all patients using DCB therapy during follow-up. CONCLUSIONS DCB therapy is safe and effective for treating peripheral arterial disease in real-world patients. Future prospective studies on this issue are recommended.
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Affiliation(s)
- Jinbo Liu
- Department of Vascular Medicine, Peking University Shougang Hospital, Beijing, P. R. of China
| | - Tianrun Li
- Department of Interventional Vascular Surgery, Peking University Third Hospital, Beijing, P. R. of China
| | - Wei Huang
- Department of Vascular Medicine, Peking University Shougang Hospital, Beijing, P. R. of China
| | - Na Zhao
- Department of Vascular Medicine, Peking University Shougang Hospital, Beijing, P. R. of China
| | - Huan Liu
- Department of Vascular Medicine, Peking University Shougang Hospital, Beijing, P. R. of China
| | - Hongwei Zhao
- Department of Vascular Medicine, Peking University Shougang Hospital, Beijing, P. R. of China
| | - Jiufeng Xu
- Department of Orthopedics, Peking University Third Hospital Yanqing Hospital, Beijing, P. R. of China
| | - Hongyu Wang
- Department of Vascular Medicine, Peking University Shougang Hospital, Beijing, P. R. of China.,Vascular Health Research Center of Peking University Health Science Center, Beijing, China
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Bulvas M, Sommerová Z, Vaněk I, Weiss J. Prospective Single-Arm Trial of Endovascular Mechanical Debulking as Initial Therapy in Patients With Acute and Subacute Lower Limb Ischemia: One-Year Outcomes. J Endovasc Ther 2019; 26:291-301. [PMID: 30955402 PMCID: PMC6537139 DOI: 10.1177/1526602819840697] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Purpose: To report the results of a prospective, single-arm study to
establish whether the initial treatment of acute or subacute limb ischemia (ALI
and SLI, respectively) can be accomplished successfully using endovascular
mechanical debulking of the target vessels to avoid the risks associated with
thrombolysis and/or open surgery. Materials and Methods: From April
2009 to April 2015, 316 consecutive patients (mean age 70.9±12 years; 184 men)
with ALI (202, 63.9%) or SLI (114, 36.1%) were enrolled; the only exclusion
criterion was irreversible ischemia. The ALI group included 146 (72.3%)
participants with category IIb ischemia and 56 (27.7%) with category IIa.
Critical limb ischemia was diagnosed in 74 (64.9%) of the 114 patients with SLI.
Target occlusions of thrombotic (n=256) or embolic (n=60) origin were located in
the femoropopliteal segment (n=231), prosthetic or venous femoropopliteal bypass
grafts (n=75), and the aortoiliac segment (n=35). The mean occlusion length was
22.9±14.8 cm. Results: The overall technical success (residual
stenosis ≤30%) was 100% after debulking and adjunctive techniques (aspiration,
dilation, stenting) at the level of the target lesions. No open surgical or
thrombolytic modalities were necessary to bypass or recanalize the target
vessels, and no death occurred in association with target occlusion therapy.
Additional infrapopliteal interventions were performed in 195 (61.7%) patients
(adjunctive thrombolysis in 29) to treat acute, subacute, and chronic lesions.
Minor complications directly related to the debulking procedure occurred in 26
(8.2%) patients. Serious complications occurred in 11 (3.5%) patients, including
hemorrhage in 8 (2.5%) patients (associated with infrapopliteal thrombolysis in
5). At 30 days, primary and secondary patency rates were 94.3% and 97.2%,
respectively; mortality was 0.3% (1 fatal intracranial hemorrhage after
adjunctive thrombolysis). Of 229 patients eligible for 1-year follow-up,
amputation-free survival was estimated to be 87.4% in 199 patients with
available data. Conclusion: In this all-comers study, mechanical
debulking with the Rotarex alone or with adjunctive techniques is feasible as a
primary therapy for occluded supratibial vessels in patients with ALI or
SLI.
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Affiliation(s)
- Miroslav Bulvas
- 1 Cardiocenter, Third Faculty of Medicine, Charles University, and Department of Surgery, Division of Interventional Angiology, University Hospital Královské Vinohrady, Prague, Czech Republic
| | - Zuzana Sommerová
- 2 Department of Internal Medicine 2, University Hospital Královské Vinohrady, Prague, Czech Republic
| | - Ivan Vaněk
- 1 Cardiocenter, Third Faculty of Medicine, Charles University, and Department of Surgery, Division of Interventional Angiology, University Hospital Královské Vinohrady, Prague, Czech Republic
| | - Jiří Weiss
- 1 Cardiocenter, Third Faculty of Medicine, Charles University, and Department of Surgery, Division of Interventional Angiology, University Hospital Královské Vinohrady, Prague, Czech Republic
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Liu J, Li T, Huang W, Zhao N, Liu H, Zhao H, Wang H. Percutaneous mechanical thrombectomy using Rotarex catheter in peripheral artery occlusion diseases - Experience from a single center. Vascular 2018; 27:199-203. [PMID: 30458685 DOI: 10.1177/1708538118813239] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
AIMS The aim of this retrospective single-center study was to analyze the immediate results, failures and complications of percutaneous mechanical thrombectomy using the Rotarex catheter in the treatment of peripheral artery occlusion. METHODS In this study, we identified a total of 42 patients who underwent mechanical thrombectomy using Rotarex catheter at our institution. Procedural outcomes and complications were evaluated. RESULTS The cohort consisted of 42 patients (31 men and 11 women), aged 32-93 years (median 68 years). The number of external iliac artery occlusion was 5, with common femoral artery 5, superficial femoral artery 28, femoral profound artery 2, popliteal artery 12, and brachial artery 2. The causes of occlusion were thrombosis (29 cases, 69%), embolism (6 cases, 14%), and reocclusion after percutaneous intervention (7 cases, 17%). We achieved primary success in 100% of the patients with mechanical thrombectomy, associated with balloon angioplasty (40/42, 95.2%) and stent deployment (16/42, 38.1%). The median time of the interventional procedure was 145 min. We encountered lower percentage of distal embolization (2.4%) and artery dissection (2.4%) during usage of Rotarex catheter in our cohort. CONCLUSIONS Rotarex thrombectomy was a useful tool to recanalize occluded vessels with additional treatment such as balloon angioplasty or stent deployment, with a low rate of failures and complications. And prospective studies in this issue are recommended.
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Affiliation(s)
- Jinbo Liu
- 1 Department of Vascular Medicine, Peking University Shougang Hospital, Beijing 100144, P. R. China
| | - Tianrun Li
- 2 Department of Interventional vascular surgery, Peking University Third Hospital, Beijing, P. R. China
| | - Wei Huang
- 1 Department of Vascular Medicine, Peking University Shougang Hospital, Beijing 100144, P. R. China
| | - Na Zhao
- 1 Department of Vascular Medicine, Peking University Shougang Hospital, Beijing 100144, P. R. China
| | - Huan Liu
- 1 Department of Vascular Medicine, Peking University Shougang Hospital, Beijing 100144, P. R. China
| | - Hongwei Zhao
- 1 Department of Vascular Medicine, Peking University Shougang Hospital, Beijing 100144, P. R. China
| | - Hongyu Wang
- 1 Department of Vascular Medicine, Peking University Shougang Hospital, Beijing 100144, P. R. China
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Giusca S, Raupp D, Dreyer D, Eisenbach C, Korosoglou G. Successful endovascular treatment in patients with acute thromboembolic ischemia of the lower limb including the crural arteries. World J Cardiol 2018; 10:145-152. [PMID: 30386492 PMCID: PMC6205845 DOI: 10.4330/wjc.v10.i10.145] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Revised: 08/07/2018] [Accepted: 08/11/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To examine the efficacy and safety of the 6 French (6F) Rotarex®S catheter system in patients with acute limb ischemia (ALI) involving thromboembolic occlusion of the proximal and mid-crural vessels.
METHODS The files of patients in our department with ALI between 2015 and 2017 were examined. In seven patients, the Rotarex®S catheter was used in the proximal segment of the crural arteries. Data related to the clinical examination, Doppler sonography, angiography and follow-up from these patients were further used for analysis.
RESULTS Two patients (29%) had thrombotic occlusion of the common femoral artery, and the remaining five exhibited thrombosis of the superficial femoral artery and popliteal artery. Mechanical thrombectomy was performed in all cases using a 6F Rotarex®S catheter. Additional Rotarex®S catheter thrombectomy due to remaining thrombus formation with no reflow was performed in the anterior tibial artery in two of seven cases (29%), in the tibiofibular tract and posterior tibial artery in two of seven cases (29%) and in the tibiofibular tract and fibular artery in the remaining three of seven cases (43%). Ischemic symptoms resolved promptly in all, and none of the patients experienced a procedural complication, such as crural vessel dissection, perforation or thrombus embolization.
CONCLUSION Mechanical debulking using the 6F Rotarex®S catheter system may be a safe and effective treatment option in case of thrombotic or thromboembolic occlusion of the proximal and mid-portion of crural arteries.
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Affiliation(s)
- Sorin Giusca
- Department of Cardiology and Vascular Medicine, GRN Hospital Weinheim, Weinheim 69469, Germany
| | - Dorothea Raupp
- Department of Gastroenterology and Diabetology, GRN Hospital Weinheim, Weinheim 69469, Germany
| | - Dirk Dreyer
- Straub Medical AG, Wangs CH-7323, Switzerland
| | - Christoph Eisenbach
- Department of Gastroenterology and Diabetology, GRN Hospital Weinheim, Weinheim 69469, Germany
| | - Grigorios Korosoglou
- Department of Cardiology and Vascular Medicine, GRN Hospital Weinheim, Weinheim 69469, Germany
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Stanek F, Ouhrabkova R, Prochazka D. Could mechanical thrombectomy replace thrombolysis in the treatment of acute and subacute limb ischemia? Minerva Cardioangiol 2018; 67:234-245. [PMID: 30160083 DOI: 10.23736/s0026-4725.18.04770-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Acute limb ischemia is a vascular emergency defined as a sudden decrease in limb perfusion associated with a risk of loss of viability of the affected extremity. Surgical treatment (Fogarty thromboembolectomy) is indicated only in suprainguinal occlusions. Other cases of acute and subacute limb ischemia should be managed percutaneously. Catheter-based treatment involves local thrombolysis and percutaneous mechanical thrombectomy (PMT). There are several devices in use for PMT; of them, the Rotarex system appears to be the most useful. There are no randomized studies comparing thrombolysis and PMT. Only indirect comparison is possible. The immediate and long-term results of PMT using the Rotarex device are probably more favorable than those following thrombolysis. Particularly for older and polymorbid patients, it may be significant that PMT, in comparison with thrombolysis, can restore blood flow faster and in one session; no contraindications for PMT in contrast to potentially life-threatening complications in thrombolysis exist, and there is also no need for observation in intensive care unit after PMT. Hospital stay after PMT is shorter. There is only one exception when thrombolysis cannot be replaced by Rotarex PMT - in the case of crural arteries involvement - due to the catheter size. In our opinion, PMT is superior to thrombolysis in the treatment of acute and subacute limb ischemia. Thrombolysis should be considered only in special cases, e.g. in crural arteries occlusions or in failure of mechanical thrombectomy.
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Affiliation(s)
- Frantisek Stanek
- Department of Cardiology, Third Faculty of Medicine, Charles University, Prague, Czech Republic - .,Department of Radiology, District Hospital Kladno, Kladno, Czech Republic -
| | | | - David Prochazka
- Department of Radiology, District Hospital Kladno, Kladno, Czech Republic
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Scheer F, Lüdtke CW, Kamusella P, Wiggermann P, Vieweg H, Schlöricke E, Lichtenberg M, Andresen R, Wissgott C. Combination of rotational atherothrombectomy and Paclitaxel-coated angioplasty for femoropopliteal occlusion. CLINICAL MEDICINE INSIGHTS-CARDIOLOGY 2015; 8:43-8. [PMID: 25983558 PMCID: PMC4406303 DOI: 10.4137/cmc.s15231] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Revised: 12/10/2014] [Accepted: 12/13/2014] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The rotational atherothrombectomy with Straub Rotarex® is a safe and efficient treatment of acute/subactute vascular occlusions. The purpose of this study was to evaluate the benefit of paclitaxel-coated angioplasty after rotational atherothrombectomy over an observation period of six months. MATERIALS AND METHODS Overall, 29 patients were treated with the Rotarex catheter in combination with paclitaxel-coated angioplasty. All patients had acute/subacute and chronic occlusions of the superficial femoral artery (SFA) and/or popliteal arteries. The ankle-brachial index (ABI) was detected before the intervention, after the procedure, and after six months. Also clinical examination and ultrasound scans were done in the observation period. RESULTS There were no technical failures. The ABI shows a significant increase from 0.52 ± 0.17 to 0.91 ± 0.25 in the follow-up. By ultrasound examination, there were found two (6.9%) restenoses during the follow-up. There was one dissection during the intervention (3.5%). CONCLUSION The rotational atherothrombectomy in combination with paclitaxel-coated angioplasty might be an effective and safe method with a promising low rate of restenosis at six months.
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Affiliation(s)
- F Scheer
- Institute of Diagnostic and Interventional Radiology/Neuroradiology, Westkuestenklinikum Heide, Academic Teaching Hospital of the Universities of Kiel, Luebeck and Hamburg, Heide, Germany
| | - C W Lüdtke
- Institute of Diagnostic and Interventional Radiology/Neuroradiology, Westkuestenklinikum Heide, Academic Teaching Hospital of the Universities of Kiel, Luebeck and Hamburg, Heide, Germany
| | - P Kamusella
- Institute of Diagnostic and Interventional Radiology/Neuroradiology, Westkuestenklinikum Heide, Academic Teaching Hospital of the Universities of Kiel, Luebeck and Hamburg, Heide, Germany
| | - P Wiggermann
- Institute of Diagnostic Radiology, University Hospital Regensburg, Regensburg, Germany
| | - H Vieweg
- Department of Radiology and Neuroradiology, Asklepios Klinik Nord - Heidberg, Hamburg, Germany
| | - E Schlöricke
- Institute of Visceral, Thoracic and Vascular Surgery, Westkuestenklinikum Heide, Academic Teaching Hospital of the Universities of Kiel, Luebeck and Hamburg, Heide, Germany
| | - M Lichtenberg
- Clinic for Angiology, Klinikum Arnsberg, Arnsberg, Germany
| | - R Andresen
- Institute of Diagnostic and Interventional Radiology/Neuroradiology, Westkuestenklinikum Heide, Academic Teaching Hospital of the Universities of Kiel, Luebeck and Hamburg, Heide, Germany
| | - C Wissgott
- Institute of Diagnostic and Interventional Radiology/Neuroradiology, Westkuestenklinikum Heide, Academic Teaching Hospital of the Universities of Kiel, Luebeck and Hamburg, Heide, Germany
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Mechanical thrombectomy of iliac vein thrombosis in a pig model using the Rotarex and Aspirex catheters. Cardiovasc Intervent Radiol 2013; 37:211-7. [PMID: 23748731 DOI: 10.1007/s00270-013-0661-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Accepted: 05/11/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE To investigate the efficacy and safety of mechanical thrombectomy for iliac vein thrombosis using Rotarex and Aspirex catheters in a pig model. MATERIALS AND METHODS Iliac vein thrombosis was induced in six pigs by means of an occlusion-balloon catheter and thrombin injection. The presence of thrombi was verified by digital subtraction angiography (DSA) and computed tomography (CT). Thrombectomy was performed using 6F and 8F Rotarex and 6F, 8F, and 10F Aspirex catheters (Straub Medical AG, Wangs, Switzerland). After intervention, DSA and CT were repeated to evaluate the efficacy of mechanical thrombectomy and to exclude local complications. In addition, pulmonary CT was performed to rule out pulmonary embolism. Finally, all pigs were killed, and iliac veins were dissected to perform macroscopic and histological examination. RESULTS Thrombus induction was successfully achieved in all animals as verified by DSA and CT. Subsequent thrombectomy lead to incomplete recanalization of the iliac veins with residual thrombi in all cases. However, the use of the 6F and 8F Rotarex catheters caused vessel perforation and retroperitoneal hemorrhage in all cases. Application of the Aspirex device caused one small transmural perforation in a vessel treated with a 10F Aspirex catheter, and this was only seen microscopically. Pulmonary embolism was detected in one animal treated with the Rotarex catheters, whereas no pulmonary emboli were seen in animals treated with the Aspirex catheters. CONCLUSION The Aspirex catheter allowed subtotal and safe recanalization of iliac vein thrombosis. In contrast, the use of the Rotarex catheter caused macroscopically obvious vessel perforations in all cases.
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Recanalization of acute and subacute venous and synthetic bypass-graft occlusions with a mechanical rotational catheter. Cardiovasc Intervent Radiol 2012; 36:936-42. [PMID: 23152037 DOI: 10.1007/s00270-012-0507-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Accepted: 09/29/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE Percutaneous mechanical thrombectomy (PMT) is now established as an alternative treatment of acute arterial occlusions in addition to fibrinolysis and surgical thrombectomy. The objective of this retrospective study was the investigation of a rotational atherothrombectomy catheter in terms of safety and efficacy in the treatment of acute and subacute femoropopliteal bypass occlusions. MATERIALS AND METHODS Forty-two patients (average age 65.8 ± 9.1 years) with acute (<14 days [n = 31]) and subacute (14-42 days [n = 11]) femoropopliteal bypass occlusions were treated consecutively with a rotational debulking and removal catheter (Straub Rotarex). The average occlusion length was 28.4 ± 2.9 (24-34) cm. Thirty-four (81%) patients underwent venous bypass, and 8 (19%) patients underwent polytetrafluoroethylene bypass. RESULTS The technical success rate was 97.6% (41 of 42). In 1 patient, blood flow could not be restored despite the use of the atherothrombectomy system. The average catheter intervention time was 6.9 ± 2.1 (4-9) min. Ankle-brachial index increased from 0.39 ± 0.13 to 0.83 ± 0.11 at discharge and to 0.82 ± 0.17 after 1 month (p < 0.05). There were a total of 2 (4.8%) peri-interventional complications: One patient developed a distal embolism, which was successfully treated with local lysis, and another patient had a small perforation at the distal anastomosis, which was successfully treated with a stent. CONCLUSION PMT with the Rotarex atherothrombectomy catheter represents a safe and effective option in the treatment of acute and subacute femoropopliteal bypass occlusions because it can quickly restore blood flow.
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Karnabatidis D, Spiliopoulos S, Tsetis D, Siablis D. Quality improvement guidelines for percutaneous catheter-directed intra-arterial thrombolysis and mechanical thrombectomy for acute lower-limb ischemia. Cardiovasc Intervent Radiol 2011; 34:1123-36. [PMID: 21882081 DOI: 10.1007/s00270-011-0258-z] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2010] [Accepted: 07/27/2011] [Indexed: 02/08/2023]
Abstract
Percutaneous catheter-directed intra-arterial thrombolysis is a safe and effective method of treating acute and subacute lower limb ischemia, as long as accurate patient selection and procedural monitoring are ensured. Although larger, controlled trials are needed to establish the role of PTDs in ALI, mechanical thrombectomy could currently be applied combined with lytic infusion in selected cases where rapid recanalization is required or as a stand-alone therapy when the administration of thrombolytic agents is contraindicated.
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Affiliation(s)
- Dimitris Karnabatidis
- Department of Radiology, Patras University Hospital, School of Medicine, Rion, Greece.
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Laganà D, Carrafiello G, Lumia D, Fontana F, Mangini M, Vizzari FA, Piffaretti G, Fugazzola C. Recanalisation of thrombotic arterial occlusions with rotational thrombectomy. LA RADIOLOGIA MEDICA 2010; 116:932-44. [PMID: 21311991 DOI: 10.1007/s11547-010-0611-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2010] [Accepted: 03/26/2010] [Indexed: 11/27/2022]
Abstract
PURPOSE This study sought to assess the effectiveness of rotational thrombectomy (RT) with the Rotarex device in the treatment of thrombotic occlusions in native arteries, by-pass grafts, stents and stent-grafts. MATERIALS AND METHODS Over the last 4 years, 22 patients (14 men and 8 women; mean age 62.6 years) affected by 5 acute (<14 days) thrombotic occlusions of the native arteries (4 plaque thromboses in the common iliac artery and one on a dissection intimal flap of the external iliac artery), 17 subacute and chronic thromboses affecting 4 femoro-popliteal by-pass grafts, 10 stents (7 in the common iliac artery and 3 in the superficial femoral artery) and 3 stents-grafts were studied. Acute thromboses of native arteries were follow-up with colour-Doppler ultrasound (US) examination at 1 and 3 months. Subacute and chronic thrombotic occlusions were follow-up with colour-Doppler US examination at 1, 3, 6 and 12 months and yearly thereafter. RESULTS Immediate technical success was achieved without any need for additional procedures in all acute occlusions of native arteries (4/22 cases). In the subacute and chronic occlusions, the procedure was completed with percutaneous transluminal angioplasty (PTA) (8/22), cutting balloon (6/22) and stenting (5/22). The complication rate was 4.8% (1 rupture of the external iliac artery repaired with a stent-graft). CONCLUSIONS Arterial recanalisation with RT is the treatment of choice for acute thrombosis of healthy native arteries (4-7 mm); the treatment of thrombosis complicating calcified plaques or dissection intimal flaps may cause rupture of the arterial wall. In subacute and chronic occlusions of by-pass grafts, stents and stent grafts, additional procedures are necessary to achieve complete recanalisation.
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Affiliation(s)
- D Laganà
- Department of Radiology, University of Insubria, V.le Borri 57, Varese, Italy.
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Massive pulmonary embolism: treatment with the rotarex thrombectomy system. Cardiovasc Intervent Radiol 2010; 34:106-13. [PMID: 20454793 DOI: 10.1007/s00270-010-9878-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2010] [Accepted: 04/15/2010] [Indexed: 12/16/2022]
Abstract
This study was designed to evaluate the efficacy and safety of percutaneous mechanical thrombectomy (PMT) for acute massive pulmonary embolism (PE). Fourteen patients (8 men, 6 women) with a mean age of 55.4 (range, 38-71) years with acute massive PE were initially diagnosed by computed tomography (CT) and confirmed by pulmonary angiography. All patients presented with acute PE symptoms and hemodynamic compromise. Each patient was treated with Straub Rotarex thrombectomy device and five patients received additional thrombolysis. Technique success and clinical improvement were achieved in all patients without major complications. The mean pulmonary artery pressure (PAP) decreased from 37.6 ± 6.6 to 29 ± 6.4 mmHg (P < 0.01) after PMT. Partial arterial pressures of O(2) (PaO(2)) increased from 61.1 ± 9.2 to 88 ± 5.1 mmHg (P < 0.01). The Miller index was 0.67 ± 0.11 and 0.37 ± 0.13 (P < 0.01), respectively, before and after PMT (P < 0.01). Eleven patients had no recurrence of PE on a mean follow-up of 28.3 months, whereas the other three patients were lost to follow-up. The preliminary experience in our series suggests that the Straub Rotarex thrombectomy device, which has been utilized in peripheral arteries, also is useful for the treatment of acute massive PE.
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Duc SR, Schoch E, Pfyffer M, Jenelten R, Zollikofer CL. Recanalization of acute and subacute femoropopliteal artery occlusions with the rotarex catheter: one year follow-up, single center experience. Cardiovasc Intervent Radiol 2006; 28:603-10. [PMID: 16132388 DOI: 10.1007/s00270-004-0339-3] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE To assess the efficacy and safety of a new rotational catheter for percutaneous removal of fresh and organized thrombi in the femoropopliteal artery. METHODS Forty-one limbs in 38 patients (age 56--90 years, mean 75.6 years) with acute, subacute or chronic femoropopliteal occlusions of 1--180 days' duration (mean 31.6 days) were treated with the Rotarex device. The Fontaine stage was mainly IIB (Rutherford 2--3, 22 patients) or III (Rutherford 4, 14 patients). The length of occlusion varied from 2 to 35 cm (mean 13.1 cm). After recanalization percutaneous transluminal angioplasty (PTA) was performed if there was a residual stenosis of >25%. Patients were followed up with color Doppler ultrasound at 48 hr and clinically with Doppler pressures and oscillometry at 3, 6, and 12 months. RESULTS After an average of two passages with the Rotarex catheter all but two limbs required PTA for residual stenosis >25%. Five patients needed additional stenting. Major complications were one groin hematoma requiring blood transfusion and one arteriovenous fistula spontaneously thrombosing after unsuccessful primary prolonged balloon dilation. Distal embolizations occurred in 10 patients; 6 clinically relevant emboli were aspirated. All occlusions were technically successfully recanalised there were 2 early reocclusions after 1 day and two at 2 weeks. Brachial-ankle indices improved from an average of 0.41 before to 0.93 after recanalization. Primary and secondary patency rates were 62% / 84% after 6 months and 39% / 68% after 1 year. The amputation-free survival at 12 months was 100%. CONCLUSION The Rotarex mechanical thrombectomy device is an efficient, quick, easy to handle, and safe tool for the treatment of acute, subacute or even chronic peripheral arterial thromboembolic occlusions. It can be used for short or long occlusions with equal success, provided the obstruction is not heavily calcified and has been safely passed with a guidewire first.
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Affiliation(s)
- Sylvain R Duc
- Department of Radiology, Kantonsspital Winterthur, Brauerstrasse 15, Winterthur 8401, Switzerland.
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Kucher N, Windecker S, Banz Y, Schmitz-Rode T, Mettler D, Meier B, Hess OM. Percutaneous Catheter Thrombectomy Device for Acute Pulmonary Embolism: In Vitro and in Vivo Testing. Radiology 2005; 236:852-8. [PMID: 16014440 DOI: 10.1148/radiol.2363041287] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To evaluate a percutaneous pulmonary embolism (PE) thrombectomy catheter that aspirates, macerates, and removes thrombus. MATERIALS AND METHODS Nine in vitro tests were performed by using porcine thrombi at a PE test station that provides continuous fluid output of 2 L/min at a pressure of 50 mmHg. Macroembolization was defined as embolized particles larger than 1.5 mm in dimension; microembolization was defined as particles that range in size from 0.1 to 1.5 mm. In static in vitro tests, researchers measured plasma-free hemoglobin levels in a 36-year-old man to assess mechanical hemolysis. Investigational review board approval and informed consent were obtained. The Department of Agriculture, Veterinary Bureau, Bern, Switzerland approved in vivo tests. Researchers investigated device effectiveness in 10 pigs that developed cardiogenic shock but survived massive PE after injection of two or three porcine thrombi into the external jugular vein via a surgically implanted 24-F sheath. Pulmonary angiography and hemodynamic measurements, including mean aortic and mean pulmonary artery pressure, heart rate, and mixed venous oxygen saturation, were obtained at baseline, after embolization, and after thrombectomy. Repeated-measures analysis of variance was performed to compare hemodynamic measurements at baseline, after embolization, and after thrombectomy. Cardiovascular structures were examined at necropsy for rupture, perforation, dissection, or hemorrhage. RESULTS During a mean aspiration time of 69 seconds +/- 19, thrombi were completely extracted from 14-mm test tubes, with an aspirated fluid volume of 201 mL +/- 64. Although no macroembolization was observed, microembolization was quantified at 1.9 g +/- 1.3. Catheter aspiration was not associated with an increase in plasma-free hemoglobin. In 10 animals, aortic pressure increased from 52 mmHg +/- 24 before thrombectomy to 90 mmHg +/- 32 after thrombectomy, mixed venous oxygen saturation increased from 48% +/- 19% to 61% +/- 12%, pulmonary artery pressure decreased from 33 mmHg +/- 9 to 22 mmHg +/- 4, and heart rate decreased from 162 beats per minute +/- 24 to 114 beats per minute +/- 14. We did not observe macro- or microscopic damage to treated or untreated cardiovascular structures. CONCLUSION The PE thrombectomy device was highly effective, facilitating rapid reversal of cardiogenic shock without device-related complications.
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Affiliation(s)
- Nils Kucher
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115, USA.
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Loupatatzis C, Stoupis C, Seiler C, Candinas D, Do DD, Triller J. Use of a Mechanical Thrombectomy Device to Recanalize a Subacutely Occluded Aortohepatic Bypass After Orthotopic Liver Transplantation. J Endovasc Ther 2005; 12:401-4. [PMID: 15943518 DOI: 10.1583/04-1447r.1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE To report the use of a rotational thrombectomy device for recanalization of a thrombosed hepatic artery bypass graft in an orthotopic liver transplant (OLT). CASE REPORT Six months after a second OLT in a 52-year-old man, an iliac conduit used for an aortohepatic bypass became occluded, interrupting arterial supply to the liver transplant. The 8-F Straub Rotarex system was used to successfully remove clot from the bypass graft, avoiding embolization to the hepatic arteries. The recanalized conduit has remained patent for 1 year with the patient on an anticoagulation regimen. CONCLUSIONS The Rotarex thrombectomy system may be considered an alternative to other percutaneous interventions for the treatment of occluded bypass conduits supplying a liver transplant.
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Affiliation(s)
- Christos Loupatatzis
- Department of Diagnostic, Interventional and Pediatric Radiology, University Hospital of Bern, Inswlspital, Bern, Switherland
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Tajima H, Murata S, Kumazaki T, Nakazawa K, Ichikawa K, Yamamoto T, Tanaka K, Takano T. Recent Advances in Interventional Radiology for Acute Massive Pulmonary Thromboembolism. J NIPPON MED SCH 2005; 72:74-84. [PMID: 15940014 DOI: 10.1272/jnms.72.74] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Acute massive pulmonary thromboembolism is life-threatening and requires vigorous treatment. Anticoagulation is the most traditional treatment for pulmonary thromboembolism, but may not be sufficient for massive thromboemboli. Systemic thrombolytic therapy and surgical thrombectomy are the traditional therapeutic options in this situation. Catheter-directed thrombolysis, percutaneous embolectomy and, more recently, percutaneous thrombus fragmentation techniques using specialized devices are now available to treat the most severe cases of massive pulmonary thromboembolism. The success of these techniques depends on a thorough understanding of the mechanism of action of each of the devices and familiarity with the relevant catheterization techniques. We present a review of currently available equipment and techniques, and describe our work with hybrid treatment using a combination of mechanical fragmentation, localized fibrinolysis and clot aspiration.
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Affiliation(s)
- Hiroyuki Tajima
- Department of Radiology, Center for Advanced Medical Technology, Nippon Medical School, Tokyo, Japan.
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Zeller T, Frank U, Bürgelin K, Müller C, Flügel P, Horn B, Schwarzwälder U, Neumann FJ. Early Experience With a Rotational Thrombectomy Device for Treatment of Acute and Subacute Infra-aortic Arterial Occlusions. J Endovasc Ther 2003. [DOI: 10.1583/1545-1550(2003)010<0322:eewart>2.0.co;2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Zeller T, Frank U, Bürgelin K, Müller C, Flügel P, Horn B, Schwarzwälder U, Neumann FJ. Early experience with a rotational thrombectomy device for treatment of acute and subacute infra-aortic arterial occlusions. J Endovasc Ther 2003; 10:322-31. [PMID: 12877617 DOI: 10.1177/152660280301000224] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To evaluate a rotational thrombectomy device in the treatment of acute and subacute/chronic thrombotic infra-aortic occlusions of native vessels and bypass grafts. METHODS From July 2000 to February 2002, 98 patients (65 men; mean age 66+/-9 years, range 47-90) with 100 thrombotic occlusions (mean age of occlusion 31+/-33 days, range 0-140) measuring an average of 21+/-11 cm long (range 2-40) were treated with rotational thrombectomy (Rotarex). There were 33 acute (</=14 days) thrombotic/embolic native artery occlusions (group I), 58 subacute/chronic (>14 days) native artery occlusions (group II), and 9 acute bypass graft occlusions (group III). RESULTS The device activation time was 4.9+/-1.4 minutes, during which 4.0+/-1.4 passes of the device were performed. The amount of aspirated fluid was 240+/-119 mL. Slightly less than half the arteries (48%) were stented. Primary success (residual stenosis <30%) was achieved in 92% (94% for group I, 93% for group II, and 78% for group III; 100% for the ipsilateral approach, 56% for the crossover approach). Among the 18 complications, 3 were serious (2 amputations after unsuccessful intervention and 1 death); there were 8 vessel perforations and 7 cases of peripheral embolization. Thirty-day survival and limb salvage was 88% for group I, 100% for group II, and 66% for group III. CONCLUSIONS The device is an easy-to-handle, useful tool for ipsilateral treatment of acute and subacute thrombotic arterial and bypass graft occlusions. The use of this device is limited by the 8-F diameter of the catheter and the limited capacity for crossover interventions.
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Affiliation(s)
- Thomas Zeller
- Department of Angiology, Heart-Center Bad Krozingen, Germany.
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Zeller T, Frank U, Bürgelin K, Sinn L, Horn B, Roskamm H. Acute thrombotic subclavian artery occlusion treated with a new rotational thrombectomy device. J Endovasc Ther 2002; 9:917-21. [PMID: 12546597 DOI: 10.1177/152660280200900629] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To report the use of a new rotational thrombectomy device for percutaneous thrombectomy of an acutely occluded subclavian artery. CASE REPORT A 71-year-old woman with a history of multivessel coronary disease complained of sudden onset of pain at rest and paleness of the left arm. Duplex ultrasound showed a localized thrombotic occlusion of the postvertebral subclavian artery and another at the bifurcation of the brachial artery. After angiographic confirmation, the subclavian artery was recanalized with an 8-F Rotarex device via a percutaneous transfemoral access; the bifurcation of the brachial artery was recanalized by local thrombolysis (50 mg rtPA) because the thrombectomy device was too short to reach the occlusion. Follow-up examinations up to 1 year have shown normalized perfusion of the left arm. CONCLUSIONS This new thrombectomy device is a useful tool for the percutaneous treatment of acute occlusion in the brachiocephalic arteries.
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Affiliation(s)
- Thomas Zeller
- Department of Angiology, Herz-Zentrum Bad Krozingen, Germany.
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Zeller T, Frank U, Bürgelin K, Sinn L, Horn B, Roskamm H. Acute Thrombotic Subclavian Artery Occlusion Treated With a New Rotational Thrombectomy Device. J Endovasc Ther 2002. [DOI: 10.1583/1545-1550(2002)009<0917:atsaot>2.0.co;2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Abstract
Venous thromboembolism is a common cause of death. Acute massive pulmonary embolism (PE) is life-threatening and may require vigorous more invasive treatment. Several risk factors are related to increased incidence of massive PE. Anticoagulation is the most traditional treatment for PE but may not suffice in cases of massive PE. Systemic thrombolytic therapy, catheter-directed thrombolysis, percutaneous embolectomy, and more recently, percutaneous thrombus fragmentation techniques with a multitude of devices are now available to treat the most severe cases of massive PE. Successful treatment of PE includes implementation of a treatment protocol and the use of associated techniques and devices.
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Affiliation(s)
- R Uflacker
- Department of Radiology, Medical University of South Carolina, Charleston 29425, USA.
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