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At least 19 recordsLinked to original sources
PubMedDate not supplied

Acute and delayed outcomes of mechanical thrombectomy with use of the steerable Amplatz thrombectomy device in a model of subacute inferior vena cava thrombosis.

PURPOSE: To study the efficacy and delayed outcome of mechanical thrombectomy with the Amplatz thrombectomy device (ATD) in an experimental model of subacute inferior vena cava (IVC) thrombosis. MATERIALS AND METHODS: Mechanical thrombectomy was performed in 23 dogs with subacute infrarenal IVC thrombosis (6-15 days old). Heparin was administered during thrombectomy in all procedures (activated clotting time > or = 300 sec). Thirteen animals were killed immediately after thrombectomy, and the remaining 10 were allowed to survive for up to 1 month with no anticoagulation therapy. RESULTS: Venographic patency of the IVC was restored in all animals, although residual mural thrombus remained in nine dogs (< 20% narrowing in seven, 20%-30% narrowing in two). No histopathologic evidence of mechanical wall disruption attributed to mechanical thrombectomy was seen. However, foci of organizing residual thrombus with associated transmural phlebitic changes with round-cellular infiltration were present in all acute specimens, including those appearing clear at venography. Venography at 1 week or 1 month after thrombectomy showed IVC rethrombosis in eight dogs (80%) who were not receiving anticoagulants. During mechanical thrombectomy, a small increase in mean pulmonary artery pressure occurred, with a corresponding decrease in systemic arterial oxygen saturation. No acute emboli were noted on the post-thrombectomy pulmonary angiograms. However, histopathologic examination of acutely explanted lungs in 11 animals showed arteriolar microemboli (100-500 microm) in four. CONCLUSION: Mechanical thrombectomy with use of the ATD can effectively clear subacute IVC thrombus. However, rethrombosis is common and may be due to the high prevalence of phlebitis and residual thrombus. Anticoagulation may need to be continued after successful thrombectomy to prevent progression of residual thrombus and allow mural phlebitic changes to subside.

Animals↗
PubMed2001

Mechanical thrombectomy of major and massive pulmonary embolism with use of the Amplatz thrombectomy device.

RATIONALE AND OBJECTIVES: To evaluate the feasibility of mechanical thrombectomy with the Amplatz thrombectomy device (ATD) in restoring patency of acutely thrombosed pulmonary arteries resulting from pulmonary embolism for the improvement of patient outcome. METHODS: Mechanical thrombectomy with the ATD (8F) was performed in nine consecutive patients with angiographically documented thrombus in the left or right pulmonary artery resulting from deep vein thrombosis (n = 4) or unknown cause (n = 5). RESULTS: The Miller index decreased from 18 to 11. In all patients, the majority of the thrombus in the pulmonary artery was cleared after a mean activation time of the ATD of 367 seconds. Thrombectomy was performed with the ATD alone (n = 4) or with additional long-term fibrinolysis therapy (n = 5) with infusion of recombinant tissue-type plasminogen activator. Pulmonary arterial pressure decreased from a mean of 57 mm Hg before mechanical thrombectomy to 55 mm Hg directly after the procedure and to 39 mm Hg after termination of the recombinant tissue-type plasminogen activator infusion. CONCLUSIONS: Mechanical thrombectomy with the ATD in patients with minor and major pulmonary embolism is technically feasible and safe. It is a potential alternative to drug-mediated thrombolysis and surgery. However, the incremental benefit of the ATD over conventional treatments could be shown only in a randomized controlled study.

Acute Disease↗
PubMed2006

Mechanical thrombectomy of acute iliofemoral deep vein thrombosis with use of an Arrow-Trerotola percutaneous thrombectomy device.

PURPOSE: To evaluate the immediate and 1-year clinical outcomes of mechanical thrombectomy with use of the Arrow-Trerotola percutaneous thrombectomy device (PTD) with or without low-dose urokinase in the treatment of acute iliofemoral deep vein thrombosis (DVT). MATERIALS AND METHODS: Mechanical thrombectomy with the PTD was performed in 25 patients with acute iliofemoral DVT. Thrombolytic therapy with low-dose urokinase was used in all patients without contraindications (n = 20). Other therapies used in combination included inferior vena cava filter insertion (n = 5), sheath aspiration thrombectomy (n = 25), and angioplasty and stent placement (n = 20). RESULTS: Initial technical and clinical success was achieved in all cases. In the 20 patients who had no contraindications to the use of urokinase, the dosage of urokinase did not exceed 1 million IU (range, 360,000-1,000,000 IU; mean, 640,000 IU). The mean time of urokinase infusion was 16 hours (range, 12-20). In five patients who had a contraindication to the use of urokinase, mechanical thrombectomy with the PTD was successful without the use of urokinase. There were no major complications. Primary patency of the stent-implanted common iliac vein segment was achieved at 1 year in 17 of 20 patients (85%). The overall 1-year clinical success rate was 92% (23 of 25 patients). Valvular insufficiency occurred in two patients (8%). CONCLUSION: The PTD is an effective mechanical thrombectomy device in the treatment of acute iliofemoral DVT with or without adjunctive urokinase thrombolysis.

Acute Disease↗
PubMedDate not supplied

Influence of thrombus age on the mechanical thrombectomy efficacy of the amplatz thrombectomy device in vitro.

PURPOSE: To determine the efficacy of thrombectomy for the Amplatz Thrombectomy Device (ATD) according to the age of the thrombus. METHODS: Thrombectomy was performed with the 7 Fr or 8 Fr ATD. Five-day-old or 8-day-old thrombi were made from porcine blood by clotting within silicone tubes to be used in a flow model. Emboli sizes, weight, remaining thrombus and activation time were evaluated. RESULTS: The age of the thrombus had no influence on the activation time necessary for complete thrombolysis. A significant difference was found in the overall amount of embolization only with the 7 Fr device although a similar trend was shown with the 8 Fr device. The amount of embolized thrombotic material was higher for both devices if older thrombi (i.e., 8 days old) were processed. The overall impression was that the 8 Fr device showed slightly better results (less remaining thrombus and embolization). CONCLUSION: A tendency toward higher amounts of embolization was observed if older thrombi were used in the model. Therefore the interventional radiologist should be aware of the potentially higher risk of peripheral embolization when performing mechanical thrombectomy (with the ATD) in older thrombotic occlusions, especially since the higher rate of embolization was mainly due to an increased proportion of larger embolic particles (1 mm), which are clinically more significant.

Animals↗
PubMed2002

A metaanalysis comparing surgical thrombectomy, mechanical thrombectomy, and pharmacomechanical thrombolysis for thrombosed dialysis grafts.

BACKGROUND: The achievement and maintenance of access sites for hemodialysis is a persistent challenge for both the vascular surgeon and the clinical nephrologist. The advent of improved interventional, endovascular, and pharmacomechanical techniques for the treatment of thrombosis has raised questions as to whether surgical thrombectomy is the most effective treatment. OBJECTIVE: The purpose of this study was to determine the role of surgical thrombectomy as the standard of care for the patient with end-stage renal disease and a thrombosed/stenosed arteriovenous graft (AVG). DESIGN AND METHODS: The study was designed as a metaanalysis. All publications that directly or indirectly described randomized controlled trials for the treatment of thrombosed dialysis grafts in patients with end-stage renal disease and AVG were searched. Relative risk (RR) and risk difference were used as the measure of effect for each dichotomous outcome. All of the studies that met the inclusion criteria were limited to prosthetic AVGs. RESULTS: The overall results suggested a clear superiority of surgery over endovascular procedures at 30 days, 60 days, 90 days, and 1 year. The RRs (95% CI) at these time points were 1.32 (1.07, 1.60), 1.34 (1.13, 1.58), 1.22 (1.05, 1.40), and 1.22 (1.07, 140), respectively, and favored surgery in all cases (30 days, P =.010; 60 days, P =.0007; 90 days, P =.007; and 1 year P =.003). The number needed to treat to prevent one endovascular occlusion after thrombectomy was 8 at 30 days, 6 at 60 days, 8 at 90 days, and 7 at 1 year. The rates of technical failure were significantly greater in the endovascular group compared with the surgical group (RR, 1.90; 95% CI, 1.32, 2.73; P =.0005), which generated an absolute risk reduction of 16% (P =.0002). No significant difference was seen in the complication rates between the two groups. CONCLUSION: The analysis of all currently available randomized controlled trials clearly supports the use of surgical thrombectomy for the treatment of thrombosed prosthetic vascular access grafts. The use of endovascular techniques has been found to be inferior to surgery in terms of both primary patency and technical failure rates.

Arteriovenous Shunt, Surgical↗
PubMed2006

Combined percutaneous aspiration thrombectomy and rheolytic thrombectomy in massive subacute vena cava thrombosis with IVC filter occlusion.

PURPOSE: To report the combined use of percutaneous aspiration thrombectomy and rheolytic thrombectomy in the setting of extensive inferior vena cava (IVC) thrombosis and filter occlusion. CASE REPORT: A 28-year-old paraplegic man with a vena cava filter in situ for previous deep vein thrombosis (DVT) was referred to our center for evaluation of dyspnea and right leg edema and swelling. Computed tomography excluded a pulmonary embolism and revealed severe, massive DVT of both iliac veins and the IVC, including the vena cava filter. Percutaneous aspiration thrombectomy was attempted because intravenous heparin therapy was ineffective, and moderate anemia contraindicated regional thrombolysis. Several passes of a guiding catheter proximally and distally to the filter, with suction provided by a 50-mL syringe, achieved minimal IVC recanalization. Subsequently, a 6-F AngioJet catheter was passed via the guiding catheter through the filter, the IVC, and both iliac veins, obtaining a satisfactory result. The patient was discharged after 7 days and did very well at 6-month follow-up, with no recurrent DVT. CONCLUSION: This case demonstrates the usefulness of combined percutaneous aspiration and rheolytic thrombectomy in treating extensive IVC thrombosis and occluded IVC filters, especially when thrombolytic therapy cannot be used.

Adult↗
PubMed2000

[Percutaneous mechanical thrombectomy for thrombosed vessels with a hydrolyser (hydrodynamic thrombectomy catheter): clinical experience].

A hydrodynamic thrombectomy catheter was prospectively evaluated for the treatment of thrombosed vessels. Seven patients (7 males: age range from 56 to 82 years; mean age: 79 years) presenting with acute or chronic occlusion of peripheral native arteries (n = 6) and dialysis shunt (n = 1) were treated with the hydrolyser (Cordis, Johnson and Johnson, Japan). Mean occlusion time was 135 days (range: 2-300 days), and mean thrombus length 16 cm (range: 5-20 cm). Removal of the thrombus was successful in five patients (71%), regardless of the length of the thrombus. Mean procedure time was 20 minutes (range: 15-30 minutes). No major complications occurred. Adjunctive thrombolysis was required for persistence of the residual thrombosed distal vessel in one patient. Adjunctive balloon angioplasty was performed in two patients (one native vessel and one dialysis shunt), and stent placement was performed in one patient (dialysis shunt). In two unsuccessful cases, the hydrolyser could not be advanced to the distal side because of the solid thrombus. Therefore, thrombolytic therapy was chosen. However, this therapy failed because the guidewire did not pass within the thrombus. Surgery was performed in these two patients. We conclude from this clinical experience that percutaneous thrombectomy with a hydrolyser is a promising technique for the treatment of thrombosed vessels. Especially in the acute stage of thrombosed occlusion, percutaneous thrombectomy with a hydrolyser is superior to thrombectomy with a Fogarty balloon catheter because of its shorter procedure time and fewer complications.

Acute Disease↗
PubMed2003

Thrombectomy with rescue percutaneous thrombectomy catheter: our initial experience.

Plaque rupture and subsequent thrombus formation inside the coronary arteries has been known for years. Mechanical devices have been used for the extraction or dissolution of thrombus inside the coronary arteries. This report illustrates the use of the Rescue Percutaneous Thrombectomy Catheter in a right coronary artery loaded with thrombus. Following thrombectomy, the stenosis in the artery was well delineated. Successful balloon angioplasty was performed, which resulted in TIMI 3 flow and no distal embolization. Rescue Percutaneous Thrombectomy Catheter has been successfully used in the setting of acute myocardial infarction. The present case illustrates that the Rescue Percutaneous Thrombectomy Catheter can be used for removing thrombus even one month after acute myocardial infarction.

Coronary Angiography↗
PubMedDate not supplied

Mechanical thrombectomy of occluded hemodialysis native fistulas and grafts using a hydrodynamic thrombectomy catheter: preliminary experience.

The purpose of this study was to evaluate the efficacy and safety of a new hydrodynamic percutaneous thrombectomy catheter in the treatment of thrombosed hemodialysis fistulas and grafts. Twenty-two patients (median age: 47 years; range: 31-79 years) underwent mechanical thrombectomy for thrombosed hemodialysis fistulas or polytetrafluoroethylene (PTFE) grafts. In all cases, an Oasis hydrodynamic catheter was used. Five patients had native fistulas and 17 had PTFE grafts. Six patients required repeat procedures. All patients with native fistulas and 15 of the 17 with PTFE grafts also underwent angioplasty of the venous limb following the thrombectomy. Major outcome measures included technical success, clinical success, primary and secondary patency, and complication rates. Twenty-eight procedures were performed in total. The technical success rate was 100% and 90% and clinical success was 86% and 76% for native fistulas and grafts, respectively. The primary patency at 6 months was 50% and 59% for fistulas and grafts, respectively, and the secondary patency at 6 months was 75% and 70% for fistulas and grafts, respectively. Two patients died of unrelated causes during the follow-up period. The Oasis catheter is an effective mechanical device for the percutaneous treatment of thrombosed hemodialysis access. Our initial success rate showed that the technique is safe in the treatment of both native fistulas and grafts.

Adult↗
PubMedDate not supplied

Emergent right coronary artery thrombectomy with a jet aspiration thrombectomy catheter.

A saline-jet aspiration thrombectomy (JAT) catheter was used in a patient with acute myocardial infarction. A right coronary arteriogram showed complete thrombotic occlusion at the proximal segment. With this catheter the thrombus was removed without complications in 5 sec. The patient underwent percutaneous transluminal coronary angioplasty and placement of a Palmaz-Schatz stent after successful thrombectomy. Thrombectomy with a JAT catheter was very useful in this patient.

Aged↗
PubMed2004

Thrombectomy for acute internal carotid thrombosis: five thrombectomy devices compared.

OBJECTIVE: To test the safety and efficiency of commercially available thrombectomy catheters in clearing simulated internal carotid artery (ICA) thrombosis. DESIGN: Comparative in vitro study. MATERIALS AND METHODS: A model of the ICA was filled with human thrombus, the 'circle of Willis' back pressure was set at either 10 or 30 cm of water. Five thrombectomy devices (Hydrolyser, Clot Buster, Acolysis System, AngioJet and Fogarty embolectomy catheter) were compared for (i) efficiency at removing thrombus, (ii) pressure changes at the tip of each device, and (iii) distal embolisation by flow cytometry. RESULTS: Thrombus clearance was greatest with the AngioJet (median 95%, range 92-97%) and least with the Acolysis System (median 34%, range 12-50%). The Clot Buster and Hydrolyser were safest as they produced only negative tip pressures, the AngioJet and Balloon catheter produced positive and negative pressures risking distal embolisation. The Acolysis system produced no pressure change during use. Distal embolisation (of particles between 5 and 40 microm diameter) was greatest with the Fogarty balloon catheter at 10 cm water (P<0.05) and least with the Hydrolyser and Clot Buster. CONCLUSION: Balloon embolectomy for ICA thrombosis risks further embolic cerebral damage. The Hydrolyser and the Clot Buster show the greatest promise for ICA thrombectomy.

Acute Disease↗
PubMedDate not supplied

Distal embolization during thrombectomy with use of the hydrolyser (hydrodynamic thrombectomy catheter): in vitro testing.

PURPOSE: To evaluate distal embolization while using the Hydrolyser (hydrodynamic thrombectomy catheter) with special attention to the severity of the stenosis and temporary distal or proximal flow obstruction. MATERIALS AND METHODS: The Hydrolyser procedure was assessed in plastic tubes (5-8 mm) with a 70% or 90% diameter stenosis with or without temporary distal flow obstruction and a 72-hour-old clot proximal to the stenosis. The weight of the embolized particles was established after passage through filters of 1,000, 500, 100, and 10 microm. To evaluate the influence of the absolute inner diameter of the stenosis 1.0-, 2.1-, and 3.0-mm stenoses were compared in 10-mm tubes. RESULTS: Thrombus removal was greater than 99.9% in all but one of the cases in the 5-8-mm tubes. Embolization with a weight of more than 1 mg was only found in tubes with a relative stenosis of 70% and a stenosis inner diameter of greater than 1.5 mm. There was a positive relationship between inner diameter of the stenosis and the amount of distal embolization. In the presence of a proximal or distal temporary flow obstruction during thrombectomy, no distal embolization greater than 1 mg was found. CONCLUSION: In this in vitro study, the Hydrolyser thrombectomy device demonstrated minimal distal embolization. The amount of distal embolization that did occur was related to the absolute stenosis diameter and could be prevented by a severe distal stenosis and/or a temporary proximal or distal flow obstruction.

Catheterization↗
PubMed1999

Mechanical thrombectomy in acute venous thrombosis using an Amplatz thrombectomy device.

Three cases of percutaneous mechanical thrombectomy using the Amplatz thrombectomy device are presented. All cases involve the application of the device in a major thoracic or abdominal vein in situations in which chemothrombolysis was contraindicated. The method of operation of the Amplatz thrombectomy device, as well as a brief overview of its clinical applications, are presented.

Acute Disease↗
PubMed2001

Comparison of the mechanical thrombectomy efficacy of the Amplatz thrombectomy device and the Cragg thrombolytic brush in vitro.

RATIONALE AND OBJECTIVES: To determine the efficacy of thrombectomy (without thrombolytic agents) for the Amplatz thrombectomy device (ATD) and the Cragg thrombolytic brush catheter (CBC) in vitro. METHODS: Thrombectomy was performed with the ATD or CBC (6F) in a flow model. Embolus sizes, weight, remaining thrombus, and activation time were evaluated. RESULTS: No significant difference in the activation time was found. The CBC produced significantly less embolism (3.3% vs. 0.03% in the 5-mm and 89% vs. 0.5% in the 7-mm model), but also much more thrombus remained in the system than with the ATD (1% vs. 41% in the 5-mm and 0.1% vs. 62% in the 7-mm model). CONCLUSIONS: The ATD can remove almost all thrombus (99%), whereas the CBC removes only up to 60%, producing fewer emboli than the ATD. This might be due to the lower rotational speed of the CBC compared with the ATD, which is 20 times greater. The soft nylon brush offers less resistance and shear force toward the thrombus than the stainless-steel impeller of the ATD. Because of the large amount of remaining thrombus, the CBC should not be used without lytic agents.

Catheterization↗
PubMedDate not supplied

Treatment of thrombosed dialysis access grafts: randomized trial of surgical thrombectomy versus mechanical thrombectomy with the Amplatz device.

PURPOSE: To report the preliminary results in a trial comparing the Amplatz mechanical thrombectomy (MT) device with surgical thrombectomy (ST) to declot occluded dialysis access grafts. PATIENTS AND METHODS: Thirty-seven patients were randomly assigned by computer to either ST (n = 18) or MT (n = 19). Diagnostic fistulograms were obtained at the end of the procedure, and Doppler ultrasound was performed at 1-month follow-up. Plasma free hemoglobin levels were measured before, immediately after, and 24 hours after the procedure in the MT group. Success was defined as initial success with restoration of flow through the graft, primary patency at 30 days, and secondary patency at 30 days. RESULTS: Technical success with MT was 89%. Primary patency in the MT series was 47% and secondary 30-day patency was 68%. Technical success with ST was 83%. Primary patency in the ST series was 77% and secondary patency at 30 days was 77%. Angioplasty (n = 18) and stent placement (n = 6) were performed in the MT cases. Angioplasty was impossible in one patient. Immediately after MT, plasma free hemoglobin levels above normal were noted in 63% of the cases, but these levels were within normal levels after 24 hours in 88% of the cases. CONCLUSION: Initial success of MT in patients with occluded dialysis access grafts is comparable to that of ST. No statistically significant differences in primary or secondary patencies were seen.

Arteriovenous Shunt, Surgical↗
PubMed2006

Novel percutaneous catheter thrombectomy in acute massive pulmonary embolism: rotational bidirectional thrombectomy (ROBOT).

BACKGROUND: Although thrombolysis is a standard therapy in cases of pulmonary embolism (PE), fatal outcome is often observed. We designed and investigated the efficacy of a novel percutaneous catheter therapy, rotational bidirectional thrombectomy (ROBOT), for PE. METHODS AND RESULTS: Eighteen patients with acute massive PE (Miller score > or = 20) were included in this study. We separated them into two groups [group A (n = 10), thrombolysis; group B (n = 8): thrombolysis and ROBOT or ROBOT alone]. There was no difference in the hemodynamic indices between the groups at diagnosis. ROBOT was designed to fragment emboli by rotating a regular pigtail catheter. Three deaths occurred in group A because of hemodynamic impairment, but there was no death in group B. One day after treatment, systolic pulmonary artery pressure had decreased from 53 +/- 8 to 30 +/- 8 mm Hg (P < 0.05) in group B and from 54 +/- 5 to 42 +/- 19 mm Hg (NS) in group A. The hospitalization period in group B was shorter than that in group A (17 +/- 6 vs. 27 +/- 10 days, P < 0.05). CONCLUSION: ROBOT therapy results in a significant, rapid improvement in the hemodynamic situation and in a better outcome than conventional therapy in patients with acute massive pulmonary embolism.

Acute Disease↗