Catheter-Directed Thrombolysis of Arterial Thrombosis

Wicky, Stéphan; Pinto, Erique; Öklü, Rahmi

doi:10.1055/s-0033-1334482

Cited by 32 publications

(28 citation statements)

References 20 publications

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“…However, major bleeding occurrences and no difference in recurrence of VTE and mortality prohibit systemic thrombolysis from becoming an acceptable standard of treatment. Subsequent percutaneous catheter and stent innovations for both arterial and venous disease have led to targeted treatment improvements which have reduced the complications encountered in systemic thrombolysis [55, 59, 60]. Targeted delivery increases drug exposure time to the actual thrombus and concomitantly limits drug exposure to that very same thrombus as compared to systemic treatment.…”

Section: Endovascular Management Of Vtementioning

confidence: 99%

Pathogenesis of Thromboembolism and Endovascular Management

et al. 2017

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Venous thromboembolism (VTE), a disease that includes deep venous thrombosis (DVT) and pulmonary embolism (PE), is associated with high mortality, morbidity, and costs. It can result in long-term complications that include postthrombotic syndrome (PTS) adding to its morbidity. VTE affects 1/1000 patients, costs $13.5 billion annually to treat, and claims 100,000 lives annually in the US. The current standard of care for VTE is anticoagulation, though thrombolysis may be performed in patients with PE and threatened limb. This review discusses pathogenesis and medical treatment of VTE and then focuses on endovascular treatment modalities. Mechanical- and catheter-directed thrombolysis (CDT) is discussed, as well as patient selection criteria, and complications. The first prospective study (CaVenT) comparing CDT with anticoagulation alone in acute DVT, despite study shortcomings, corroborates the existing literature indicating improved outcomes with CDT. The potential of the ongoing prospective, multicenter, randomized ATTRACT trial is also highlighted.

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Section: Endovascular Management Of Vtementioning

confidence: 99%

Pathogenesis of Thromboembolism and Endovascular Management

et al. 2017

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“…134,135 Catheter-directed thrombolysis can also be performed in conjunction with thrombectomy or with high-frequency low-intensity ultrasound waves to accelerate clot dissolution by dissociating the fibrin strands. 135 Today, the indications for thrombolysis cover practically all forms of thrombi. Further discussion of this topic is beyond the scope of this article.…”

Section: Thrombolysismentioning

confidence: 99%

From Fibrinolysis to the Plasminogen–Plasmin System and Beyond: A Remarkable Growth of Knowledge, with Personal Observations on the History of Fibrinolysis

Kwaan

2014

Semin Thromb Hemost

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Great advances have been made in our understanding of the fibrinolytic system from the initial discovery of proteolysis of fibrin by plasmin to the multifaceted and complex role of the plasminogen?plasmin (P?P) system. We now know that the P?P system is composed of several serine proteases and their inhibitors (serpins). This system is involved in many physiological functions, including embryogenesis, cell migration, and wound healing. They also play an important role in the pathogenesis of many diseases, including atherosclerosis, obesity, cancer, and even autoimmune disorders, and neuronal degeneration. Knowledge of their role in cancer enables their use as a prognostic factor. Therapeutic use of various forms of proteases derived from this system has been employed as thrombolytic agents. In addition, small molecules designed to inhibit many of the components of the P?P system are now available for clinical trial, aimed at treatment of these various disorders. The history of such remarkable development of our knowledge on fibrinolysis is reviewed in this article.

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“…1B). 10, 23–28 The resulting venous wall stiffness and venous hypertension, 20, 29 may clinically manifest as post-thrombotic syndrome, causing edema, pain, and in severe cases ulceration of the affected limb. 14, 17 …”

Section: Introductionmentioning

confidence: 99%

Bioprinted thrombosis-on-a-chip

et al. 2016

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Thrombosis and its complications are among the most prevalent medical problems. Despite advancements in medical therapies, there is often incomplete resolution of these issues. The residual thrombus can undergo fibrotic changes over time through invaded fibroblasts from the surrounding tissues and eventually lead to the formation of a permanent clot. In order to understand the importance of cellular interactions and the impact of potential therapeutics to treat thrombosis, an in vitro platform using human cells and blood components would be beneficial. Towards achieving this aim, there have been studies utilizing the capabilities of microdevices to study the hemodynamics associated with thrombosis. In this work, we have further exploited the utilization of 3D bioprinting technology, for the construction of a highly biomimetic thrombosis-on-a-chip model. The model consisted of microchannels coated with a layer of confluent human endothelium embedded in a gelatin methacryloyl (GelMA) hydrogel, where human whole blood was infused and induced to form thrombi. Continuous perfusion with tissue plasmin activator led to dissolution of non-fibrotic clots, revealing clinical relevance of the model. Further encapsulating fibroblasts in the GelMA matrix demonstrated the potential migration of these cells into the clot and subsequent deposition of collagen type I over time, facilitating fibrosis remodeling that resembles the in vivo scenario. Our study suggests that in vitro 3D bioprinted blood coagulation models can be used to study the pathology of fibrosis, and particularly, in thrombosis. This versatile platform may be conveniently extended to other vascularized fibrosis models.

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Catheter-Directed Thrombolysis of Arterial Thrombosis

Cited by 32 publications

References 20 publications

Pathogenesis of Thromboembolism and Endovascular Management

Pathogenesis of Thromboembolism and Endovascular Management

From Fibrinolysis to the Plasminogen–Plasmin System and Beyond: A Remarkable Growth of Knowledge, with Personal Observations on the History of Fibrinolysis

Bioprinted thrombosis-on-a-chip

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