Catheter directed thrombolysis

(Redirected from Thrombolysis)

[Explanation of procedure]

Pre-procedural evaluation and patient management

Indications/Contraindications

Indications

  • Occlusion with viable extremity, organ, or graft
  • Conversion of occlusion to stenosis before angioplasty or stenting
  • Massive PE
  • Extensive DVT

Contraindications

  • Irreversible organ or limb loss
  • Active or recent bleeding
  • Recent surgery or bleeding
  • Craniotomy within 2 months, stroke within 6 months
  • Brain tumors, prior spontaneous intracranial hemorrhage
  • Demented or uncooperative patient

Technique

Catheter directed thrombolysis parameters

  • Park a catheter (various systems available) near or along thrombus, run TPA at 0.5-1 mg/hr.
  • Low dose heparin through the sheath
  • Concurrent systemic heparin infusion (aPTT goal 40-60)
  • q1h neurovascular checks
  • q4h aPTT, CBC, fibrinogen (keep >100)
  • Strict bedrest and accessed limb immobilized
  • Foley catheter
  • Minimize blood draws
  • No additional arterial access

Manual pulse-spray pharmacomechanical thrombolyis parameters (eg. AngioJet Power Pulse Spray)

  • 6 mg tPA in 50 mL normal saline infused along thrombus

Immediate and long-term complications

  • 0.5-2% risk of CNS bleeding, risk persists up to 24 hours after therapy
  • Distal emboli of thrombus fragments which resolve with continued therapy

Post-procedural evaluation and patient management

Contributing Authors

Kevin Liu