Skip to main content
SpringerLink
Log in

Thrombolysis, Mechanical Thrombectomy and Percutaneous Aspiration Thrombectomy

  • Chapter
Vascular Interventional Radiology

Part of the book series: Medical Radiology ((Med Radiol Diagn Imaging))

  • 2396 Accesses

Abstract

Over the past 25 years there have been many developments in the percutaneous minimally invasive dissolution and removal of thrombus from the vasculature. Available methods include lysis by drugs, which enhance the body’s native thrombolytic system, and those which involve physical maceration and/or removal of clot. This chapter will focus in particular on the use of these techniques in acute arterial ischaemia. Surgical options in this condition include balloon embolectomy, bypass grafting and primary amputation. This cohort of patients frequently has much comorbidity and percutaneous methods offer a potentially less invasive option.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 99.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 129.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 199.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  • Ansel GM, George BS, Botti CF et al (2002) Rheolytic thrombectomy in the management of limb ischaemia: 30-day results from a multicenter registry. J Endovasc Ther 9:395–402

    Article  PubMed  Google Scholar 

  • Arko FR, Davis CM 3rd, Murphy EH et al (2007) Aggressive percutaneous mechanical thrombectomy of deep venous thrombosis: early clinical results. Arch Surg 142:513–519

    Article  PubMed  Google Scholar 

  • Barth KH, Gosnell MR, Palestrant AM et al (2000) Hydrodynamic thrombectomy system versus pulse-spray thrombolysis for thrombosed hemodialysis grafts: a multicenter prospective randomized comparison. Radiology 217:678–684

    PubMed  CAS  Google Scholar 

  • Belkin M, Donaldson MC, Whittemore AD et al (1990) Observations on the use of thrombolytic agents for thrombotic occlusion of infrainguinal vein grafts. J Vasc Surg 11:289–294

    PubMed  CAS  Google Scholar 

  • Berridge DC, Kessel DO, Robertson I (2002) Surgery versus thrombolysis for initial management of acute limb ischaemia (systematic review). Cochrane Database Syst Rev 3:CD002784

    Google Scholar 

  • Braaten JV, Goss RA, Francis CW (1997) Ultrasound reversibly disaggregates fibrin fibers. Thromb Haemost 78:1063–1068

    PubMed  CAS  Google Scholar 

  • Braithwaite BD, Buckenham TM, Galland RB et al (1997) Prospective randomized trial of high-dose bolus versus low-dose tissue plasminogen activator infusion in the management of acute limb ischaemia. Thrombolysis study group. Br J Surg 84:646–650

    Article  PubMed  CAS  Google Scholar 

  • Buckenham TM, George CD, Chester JF et al (1992) Accelerated thrombolysis using pulsed intra-thrombus recombinant human tissue type plasminogen activator (rt-PA). Eur J Vasc Surg 6:237–240

    Article  PubMed  CAS  Google Scholar 

  • Centeno RF, Nguyen AH, Ketterer C et al (1999) An alternative approach: antegrade catheter-directed thrombolysis in a case of phlegmasia cerulea dolens. Am Surg 65:229–231

    PubMed  CAS  Google Scholar 

  • Cleveland TJ, Cumberland DC, Gaines PA (1994) Percutaneous aspiration thromboembolectomy to manage the embolic complications of angioplasty and as an adjunct to thrombolysis. Clin Radiol 49:549–552

    Article  PubMed  CAS  Google Scholar 

  • Comerota AJ, Paolini D (2007) Treatment of acute iliofemoral deep venous thrombosis: a strategy of thrombus removal. Eur J Vasc Endovasc Surg 33:351–360

    Article  PubMed  CAS  Google Scholar 

  • Cowling MG, Belli AM, Buckenham TM (1996) Evaluation and complications of direct graft puncture in thrombolysis and other interventional techniques. Cardiovasc Intervent Radiol 19:82–84

    Article  PubMed  CAS  Google Scholar 

  • Cowling MG, Buckenham TM, Belli AM (1997) The role of transradial diagnostic angiography. Cardiovasc Intervent Radiol 20:103–106

    Article  PubMed  CAS  Google Scholar 

  • Divi V, Proctor MC, Axelrod DA et al (2005) Thoracic outlet decompression for subclavian vein thrombosis: experience in 71 patients. Arch Surg 140:54–57

    Article  PubMed  Google Scholar 

  • Dotter CT, Rosch J, Seaman AJ (1974) Selective clot lysis with low dose streptokinase. Radiology 111:31–37

    PubMed  CAS  Google Scholar 

  • Drasler WJ, Jenson ML, Wilson GJ et al (1992) Rheolytic catheter for percutaneous removal of thrombus. Radiology 182:263–267

    PubMed  CAS  Google Scholar 

  • Dregelid EB, Stangeland LB, Eide GE et al (1987) Patient survival and limb prognosis after arterial embolectomy. Eur J Vasc Surg 1:263–271

    Article  PubMed  CAS  Google Scholar 

  • Dunbar Y, Hill R, Dickson R et al (2003) Comparative efficacy of thrombolytics in acute myocardial infarction. QJM 96:155–160

    Article  Google Scholar 

  • Earnshaw JJ, Whitman B, Foy C (2004) National audit of thrombolysis for acute leg ischaemia (NATALI): clinical factors associated with early outcome. J Vasc Surg 39:1018–1025

    Article  PubMed  Google Scholar 

  • Frisoli JK, Sze D (2003) Mechanical thrombectomy for the treatment of lower extremity deep vein thrombosis. Tech Vasc Interv Radiol 6:49–52

    Article  PubMed  Google Scholar 

  • Greenfield LJ, Kimmell GO, McCurdy WC (1969) Transvenous removal of pulmonary emboli by vacuum-cup catheter technique. J Surg Res 9:347–352

    Article  PubMed  CAS  Google Scholar 

  • Hall TB, Matson M, Belli AM (2001) Thrombolysis in the peripheral vascular system. Eur Radiol 11:439–445

    Article  PubMed  CAS  Google Scholar 

  • Hardig BM, Persson HW, Olsson SB (2006) Low-energy ultrasound exposure of the streptokinase molecule may enhance but also attenuate its fibrinolytic properties. Thromb Res 117:713–720

    Article  PubMed  Google Scholar 

  • Haskal ZJ (2002) Mechanical thrombectomy devices for the treatment of peripheral arterial occlusions. Rev Cardiovasc Med 3(2):S45–S52

    PubMed  Google Scholar 

  • Hopfner W, Vicol C, Bohndorf K et al (1999) Shredding embolectomy thrombectomy catheter for treatment of acute lower-limb ischaemia. Ann Vasc Surg 13:426–435

    Article  PubMed  CAS  Google Scholar 

  • Karnabatidis D, Spiliopoulos S, Tsetis D et al (2011) Quality improvement guidelines for percutaneous catheter-directed intra-arterial thrombolysis and mechanical thrombectomy for acute lower-limb ischemia. Cardiovasc Intervent Radiol 34(6):1123–1136

    Google Scholar 

  • Kasirajan K, Haskal ZJ, Ouriel K (2001) The use of mechanical thrombectomy devices in the management of acute peripheral arterial occlusive disease. J Vasc Interv Radiol 12:405–411

    Article  PubMed  CAS  Google Scholar 

  • Kessel DO, Patel JV (2005) Current trends in thrombolysis: implications for diagnostic and interventional radiology. Clin Radiol 60:413–424

    Article  PubMed  CAS  Google Scholar 

  • Kessel DO, Berridge DC, Robertson I (2004) Infusion techniques for peripheral arterial thrombolysis. Cochrane Database Syst Rev 1:CD000985

    Google Scholar 

  • Kuntz RE, Baim DS, Cohen DJ et al (2002) A trial comparing rheolytic thrombectomy with intracoronary urokinase for coronary and vein graft thrombus (the vein graft angiojet study [VeGAS 2]). Am J Cardiol 89:326–330

    Article  PubMed  CAS  Google Scholar 

  • Lagana D, Carrafiello G, Lumia D et al (2011) Recanalisation of thrombotic arterial occlusions with rotational thrombectomy. Radiol Med 116(6):932–944

    Article  PubMed  CAS  Google Scholar 

  • Lajvardi A, Trerotola SO, Strandberg JD et al (1995) Evaluation of venous injury caused by a percutaneous mechanical thrombolytic device. Cardiovasc Intervent Radiol 18:172–178

    Article  PubMed  CAS  Google Scholar 

  • Morgan R, Belli AM (2002) Percutaneous thrombectomy: a review. Eur Radiol 12:205–217

    Article  PubMed  Google Scholar 

  • Muller-Hulsbeck S, Jahnke T (2003) Peripheral arterial applications of percutaneous mechanical thrombectomy. Tech Vasc Interv Radiol 6:22–34

    Article  PubMed  Google Scholar 

  • Nazarian GK, Qian Z, Coleman CC et al (1994) Hemolytic effect of the Amplatz thrombectomy device. J Vasc Interv Radiol 5:155–160

    Article  PubMed  CAS  Google Scholar 

  • O’Sullivan GJ (2011) The role of interventional radiology in the management of deep venous thrombosis: advanced therapy. Cardiovasc Intervent Radiol 34:445–461

    Article  PubMed  Google Scholar 

  • Ouriel K, Shortell CK, DeWeese JA et al (1994) A comparison of thrombolytic therapy with operative revascularization in the initial treatment of acute peripheral arterial ischaemia. J Vasc Surg 19:1021–1030

    Article  PubMed  CAS  Google Scholar 

  • Ouriel K, Veith FJ, Sasahara AA (1998) A comparison of recombinant urokinase with vascular surgery as initial treatment for acute arterial occlusion of the legs. Thrombolysis or peripheral arterial surgery (TOPAS) investigators. N Engl J Med 338:1105–1111

    Article  PubMed  CAS  Google Scholar 

  • Parikh S, Motarjeme A, McNamara T et al (2008) Ultrasound-accelerated thrombolysis for the treatment of deep vein thrombosis: initial clinical experience. J Vasc Interv Radiol 19:521–528

    Article  PubMed  Google Scholar 

  • Pillari G, Doscher W, Fierstein J et al (1983) Low-dose streptokinase in the treatment of celiac and superior mesenteric artery occlusion. Arch Surg 118:1340–1342

    Article  PubMed  CAS  Google Scholar 

  • Pianta MJ, Thomson KR (2011) Catheter-directed thrombolysis of lower limb thrombosis. Cardiovasc Intervent Radiol 34(1):25–36

    Google Scholar 

  • Robertson I, Kessel DO, Berridge DC (2010) Fibrinolytic agents for peripheral arterial occlusion. Cochrane Database Syst Rev 3:CD001099

    Google Scholar 

  • Rocek M, Peregrin JH, Lasovickova J et al (2000) Mechanical thrombolysis of thrombosed hemodialysis native fistulas with use of the arrow-trerotola percutaneous thrombolytic device: our preliminary experience. J Vasc Interv Radiol 11:1153–1158

    Article  PubMed  CAS  Google Scholar 

  • Rudy DC, Parker TW, Seigel RS et al (1982) Segmental renal artery emboli treated with low-dose intra-arterial streptokinase. Urology 19:410–413

    Article  PubMed  CAS  Google Scholar 

  • Schrijver A, Vos J, Hoksbergen AW et al (2011) Ultrasound-accelerated thrombolysis for lower extremity ischemia: multicenter experience and literature review. J Cardiovasc Surg (Torino) 52(4):467–476

    CAS  Google Scholar 

  • Sharafuddin MJ, Hicks ME, Jenson ML et al (1997) Rheolytic thrombectomy with use of the angiojet-F105 catheter: preclinical evaluation of safety. J Vasc Interv Radiol 8:939–945

    Article  PubMed  CAS  Google Scholar 

  • Siddiqi F, Odrljin TM, Fay PJ et al (1998) Binding of tissueplasminogen activator to fibrin: effect of ultrasound. Blood 91:2019–2025

    PubMed  CAS  Google Scholar 

  • Silingardi R, Cataldi B, Moratto et al (2010) Mechanical thrombectomy in in-stent restenosis: preliminary experience at the iliac and femoropopliteal arteries with the Rotarex system. J Cardiovasc Surg (Torino) 51(4):543–550

    Google Scholar 

  • Stainken BF (2003) Mechanical thrombectomy: basic principles, current devices, and future directions. Tech Vasc Interv Radiol 6:2–5

    Article  PubMed  Google Scholar 

  • Stanek F, Ouhrabkova R, Prochazka D (2010) Mechanical thrombectomy using the Rotarex catheter—safe and effective method in the treatment of peripheral arterial thromboembolic occlusions. Vasa 39(4):334–340

    Article  PubMed  CAS  Google Scholar 

  • Starck EE, McDermott JC, Crummy AB et al (1985) Percutaneous aspiration thromboembolectomy. Radiology 156:61–66

    PubMed  CAS  Google Scholar 

  • Sullivan KL, Gardiner GAJ, Kandarpa K et al (1991) Efficacy of thrombolysis in infrainguinal by-pass grafts. Circulation 83(Suppl 2):99–105

    Google Scholar 

  • Symes JF, Graham AM, Stein L, Sniderman AD (1984) Salvage of a severely ischemic limb by arteriovenous revascularization: a case report. Can J Surg 27:274–277

    PubMed  CAS  Google Scholar 

  • The STILE investigators (1994) Results of a prospective randomized trial evaluating surgery versus thrombolysis for ischaemia of the lower extremity. The STILE trial. Ann Surg 220:251–266

    Article  Google Scholar 

  • Thomas SM, Gaines PA (1999) Vascular surgical society of Great Britain and Ireland: avoiding the complications of thrombolysis. Br J Surg 86:710

    Article  PubMed  Google Scholar 

  • Trerotola SO, Davidson DD, Filo RS et al (1996) Preclinical in vivo testing of a rotational mechanical thrombolytic device. J Vasc Interv Radiol 7:717–723

    Article  PubMed  CAS  Google Scholar 

  • Tsivgoulis G, Eggers J, Ribo M et al (2010) Safety and efficacy of ultrasound-enhanced thrombolysis: a comprehensive review and meta-analysis of randomized and nonrandomized studies. Stroke 41:280–287

    Article  PubMed  Google Scholar 

  • van Ommen VG, van der Veen FH, Geskes GG et al (1996) Comparison of arterial wall reaction after passage of the hydrolyser device versus a thrombectomy balloon in an animal model. J Vasc Interv Radiol 7:451–454

    Article  PubMed  Google Scholar 

  • Vedantham S, Thorpe PE, Cardella JF et al (2009) Quality improvement guidelines for the treatment of lower extremity deep vein thrombosis with use of endovascular thrombus removal. J Vasc Interv Radiol 20(Suppl 7):s227–s239

    Article  PubMed  Google Scholar 

  • Vesely TM (2003) Mechanical thrombectomy devices to treat thrombosed hemodialysis grafts. Tech Vasc Interv Radiol 6:35–41

    Article  PubMed  Google Scholar 

  • Vesely TM, Hovsepian DM, Darcy MD et al (2000) Angioscopic observations after percutaneous thrombectomy of thrombosed hemodialysis grafts. J Vasc Interv Radiol 11:971–977

    Article  PubMed  CAS  Google Scholar 

  • Wagner HJ, Starck EE (1992) Acute embolic occlusions of the infrainguinal arteries: percutaneous aspiration embolectomy in 102 patients. Radiology 182:403–407

    PubMed  CAS  Google Scholar 

  • Wagner HJ, Starck EE, Reuter P (1994) Long-term results of percutaneous aspiration embolectomy. Cardiovasc Intervent Radiol 17:241–246

    Article  PubMed  CAS  Google Scholar 

  • Watson LI, Armon MP (2004) Thrombolysis for acute deep vein thrombosis. Cochrane Database Syst Rev 4:CD002783

    Google Scholar 

  • Wissgott C, Kamusella P, Andresen R (2011a) Treatment of in-stent reocclusions of femoropopliteal arteries with mechanical rotational catheters. Rofo 183(10):939–944

    Article  PubMed  CAS  Google Scholar 

  • Wissgott C, Kamusella P, Andresen R (2011b) Treatment of chronic occlusions of the iliac or femoropopliteal arteries with mechanical rotational catheters. Rofo 183(10):945–951

    Article  PubMed  CAS  Google Scholar 

  • Working Party on Thrombolysis in the Management of Limb Ischaemia (2003) Thrombolysis in the management of lower limb peripheral arterial occlusion—a consensus document. J Vasc Interv Radiol 14:S337–S349

    Article  Google Scholar 

  • Zehnder T, Birrer M, Do DD et al (2000) Percutaneous catheter thrombus aspiration for acute or subacute arterial occlusion of the legs: how much thrombolysis is needed? Eur J Vasc Endovasc Surg 20:41–46

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiology, St George’s Hospital, Blackshaw Road, London, SW17 0QT, UK

    Gerard S. Goh, Robert Morgan & Anna-Maria Belli

Authors
  1. Gerard S. Goh
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Robert Morgan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Anna-Maria Belli
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Gerard S. Goh .

Editor information

Editors and Affiliations

  1. Dept. Radiology, University Hospital North Staffordshire, Newcastle Rd., Stoke-on-Trent, ST4 6QG, United Kingdom

    Mark G. Cowling

Rights and permissions

Reprints and permissions

Copyright information

© 2012 Springer-Verlag Berlin Heidelberg

About this chapter

Cite this chapter

Goh, G.S., Morgan, R., Belli, AM. (2012). Thrombolysis, Mechanical Thrombectomy and Percutaneous Aspiration Thrombectomy. In: Cowling, M. (eds) Vascular Interventional Radiology. Medical Radiology(). Springer, Berlin, Heidelberg. https://doi.org/10.1007/174_2012_568

Download citation

  • DOI: https://doi.org/10.1007/174_2012_568

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-27877-8

  • Online ISBN: 978-3-642-27878-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation