Mechanical versus chemical thrombolysis: an in vitro differentiation of thrombolytic mechanisms.

Journal Article

PURPOSE: To assess differing mechanisms of thrombolysis determining time to reperfusion, completeness of thrombus dissolution, and embolic potential. MATERIALS AND METHODS: An in vitro perfusion model designed to mimic arterial flow conditions was created. Bifurcated limbs allowed continuous flow through one channel and the placement of radiolabeled (iodine-125) thrombus housed in a 5-cm segment of polytetrafluoroethylene graft in the other. The three experimental groups consisted of a standard continuous urokinase infusion, a pulsed pressurized injection of saline, and a similar injection with urokinase. A continuous infusion of 5% dextrose served as a control group. Time to reflow (as assessed with ultrasonic flow monitoring), completeness of thrombus dissolution (I-125 liberated into solution), and the number and size of embolic particles produced (detected by a series of graduated filter sizes) were analyzed. RESULTS: Time to reflow was significantly faster for both groups when pressurized injections were used (P < .001). There was no reflow in the control arm at 90 minutes. Completeness of thrombus dissolution was higher when a continuous infusion of urokinase was used in comparison to either of the power injection groups or the control (P < .05). The amount of embolic debris produced was significantly lower with a continuous infusion of urokinase compared with either of the power lysis groups (P < .05), but significantly greater than the control arm (P < .001). The size of the embolic particles in the power pulsed lysis groups was significantly decreased by the addition of urokinase (P < .05). CONCLUSIONS: Reflow is more rapidly established by the use of mechanical means. However, a less complete dissolution of thrombus in conjunction with a greater amount of embolic debris is achieved with this approach. The size of the embolic particles produced is reduced by the addition of a thrombolytic agent.

Full Text

Duke Authors

Cited Authors

  • Greenberg, RK; Ouriel, K; Srivastava, S; Shortell, C; Ivancev, K; Waldman, D; Illig, K; Green, R

Published Date

  • February 2000

Published In

Volume / Issue

  • 11 / 2 Pt 1

Start / End Page

  • 199 - 205

PubMed ID

  • 10716390

Electronic International Standard Serial Number (EISSN)

  • 1535-7732

International Standard Serial Number (ISSN)

  • 1051-0443

Digital Object Identifier (DOI)

  • 10.1016/s1051-0443(07)61465-1

Language

  • eng