Comparative study on catheter directed thrombolysis – continuoustissue plasminogen activator vs angiojet catheter power pulse spray rheolytic thrombectomy outcome study – single-center experience
Odeh K, Ullah R, Hashim H, et al. Comparative Study On Catheter-Directed Thrombolysis – Continuous Tissue Plasminogen Activator Versus Angiojet Catheter Power Pulse Spray Rheolytic Thrombectomy Outcome Study: Single-Center Experience. Journal of the American College of Cardiology. 2017;69(11):2016. doi:10.1016/s0735-1097(17)35405-0.
BACKGROUND: Acute arterial occlusion of native and graft vessels has a variety of treatment options, including catheter-directed thrombolysis (CDT), power pulse spray with rheolytic thrombectomy (PPSRT) and surgery. We studied acute limb ischemia (ALI) outcomes with CDT vs PPSRT with adjunctive CDT as crossover at a tertiary care center.
METHODS: We undertook a comprehensive retrospective analysis of ALI (<14 days of symptom onset) patients treated with CDT (Group 1) and PPSRT with adjunctive CDT as crossover (Group 2). Data were collected from electronic medical records and billing codes. Continuous variables were expressed as mean ± standard deviation and range, and categorical variables as frequency and percentage. Differences between the groups were analyzed with t-tests or analysis of variance and chi-square or Fisher's exact test.
RESULTS: A total of 243 patients admitted for ALI were divided into Group 1 (n=165, 68%; mean age 67.3±13.8, females 48.5%) and Group 2 (n=78, 32%; mean age 68.5±14.4, females 53.8%). Based on propensity-matched comparison, there was less preprocedure tissue loss in Group 1 than Group 2 (5.5% vs 11%, p=0.022 [OR 0.35; 95% CI, 0.14-0.89]). Acute Rutherford IIa (26% vs 41%) and IIb (57% vs 36%) with p=0.059 were not statistically significant. Achieving complete lysis >95% (72% vs 83%, p=0.134) was not statistically different between the two groups. Major bleeding (21% vs 9%, p=0.029 [OR 2.56; 95% CI, 1.08-6.07]), post-lysis 30-day embolectomy (16% vs 5%, p=0.017 [OR 3.52; 95% CI 1.19-10.45]), 30-day compartment syndrome (9% vs 1%, p=0.042 [OR 6.95; 95% CI, 0.9-53.88]), length of hospitalization (7% vs 4%, p=0.0004) and time to lysis (24 hrs vs 3 hrs, p<0.001) were significantly greater in Group 1.
CONCLUSIONS: Although there was no difference in achieving complete lysis in CDT or PPSRT with adjunctive CDT, there was less major bleeding, post-lysis 30-day embolectomy and 30-day compartment syndrome, as well as shorter length of hospitalization and time to lysis in Group 2. These data support the utility of PPSRT with adjunctive CDT over CDT alone.