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This study compared the time to reperfusion and safety of intra-arterial mechanical thrombectomy by aspiration (MTA) against slow infusion of intra-arterial thrombolytics (IAT) in a cohort of patients with peripheral or visceral arterial occlusions or emboli. Materials: A single center case review of 51 patients was conducted at our institution: 24 (47.1%) patients were treated with MTA by the Penumbra Indigo Aspiration System. Twenty-seven (52.9%) were treated with a slow infusion of IAT with rt-PA. Post-procedural thrombolysis in myocardial infarction (TIMI) scores of 2-3 were used as a marker for successful reperfusion. Serious adverse events (SAEs) within 24 hours of enrollment were assessed to monitor safety. Results: All patients presented with TIMI 0-1 at pre-treatment. MTA resulted in a significant reduction in time to reperfusion (TIMI 2-3) when compared to slow infusion of IAT. The mean treatment time to reperfusion was 91.6 þ 50.34 min (range 41.3, 141.9) for MTA patients and 1313 þ 565min (range 748, 1878) for IAT patients (po0.0001). Successful revascularization (TIMI 2-3) was achieved in 90% of MTA patients versus 84.6% of the IAT patients (p ¼ 0.6836). At 24 hours, 7 MTA patients experienced SAEs but none were device-related. 4 IAT patients had 4 SAEs and all were related to the treatment. There was 1 case of a serious bleeding event in the MTA group, and 4 cases of serious bleeding events in the IAT group. Conclusions: Compared to lytic treatment alone, the use of mechanical thrombectomy by aspiration resulted in a dramatic reduction in time to reperfusion over slow infusion of IA lytic treatment. We concluded that the Penumbra Indigo System has considerable potential to improve the standard of care and reduce the costs of hospitalization in the management of peripheral and visceral arterial occlusive diseases. These findings will need to be further corroborated with future prospective studies.

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