Could mechanical thrombectomy replace thrombolysis in the treatment of acute and subacute limb ischemia?

Staněk, František; Ouhrabková, R; Prochazka, David

doi:10.23736/s0026-4725.18.04770-9

Cited by 6 publications

(6 citation statements)

References 39 publications

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“…Only indirect comparison is possible. The short-and long-term results of MATH using the Rotarex S device are probably more favorable than those following lytic therapy (3,4). Especially for old patients and those with comorbidities, it may be significant that Rotarex S MATH, in comparison with lytic treatment, may restore blood flow faster and in one single session (25).…”

Section: Rotarex S "Math" Vs Thrombolysismentioning

confidence: 99%

“…So far, there are no clear therapy recommendations for acute occlusions. Local thrombolysis is indirectly recommended in stages I and IIa according to the TASC criteria, with mechanical thrombectomy as an alternative (3,4). In cases of acute, limb-endangering ischemia (stages IIb and III), immediate reperfusion is necessary, usually by surgical approach, but mechanical thrombectomy is also an alternative in this specific situation.…”

Section: Introductionmentioning

confidence: 99%

“…In cases of acute, limb-endangering ischemia (stages IIb and III), immediate reperfusion is necessary, usually by surgical approach, but mechanical thrombectomy is also an alternative in this specific situation. Because the results of surgical treatment are often incompletely satisfactory and are associated with higher morbidity and mortality rates, local intraarterial lysis has prevailed, at least in stages I and IIa, as the standard intervention (3,4). However, even thrombolysis is associated with systemic complications.…”

Section: Introductionmentioning

confidence: 99%

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Percutaneous Rotational Mechanical Atherectomy Plus Thrombectomy Using Rotarex S Device in Patients With Acute and Subacute Lower Limb Ischemia: A Review of Safety, Efficacy, and Outcomes

Loffroy¹,

Falvo²,

Galland³

et al. 2020

Front. Cardiovasc. Med.

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Acute and subacute ischemia of lower limbs is associated with high risk of amputation and potential severe life-threatening complications. Despite a lack of clear therapeutic recommendations, surgical treatments such as thrombectomy or bypass and/or catheter-directed thrombolysis (CDT) have been first-line procedures in both acute and subacute limb ischemia, but each therapy may lead to significant morbidity and mortality. Such situations demand fast restoration of appropriate flow to preclude limb loss and other complications. Percutaneous mechanical atherectomy plus thrombectomy (MATH) represents a minimally invasive approach for quickly recanalizing thrombus-containing lesions whatever the age of thrombus. Indeed, many chronic patients can present with critical limb ischemia, with thrombus-containing occlusive lesions triggered by underlying atherosclerotic disease. MATH offers various advantages over surgery and CDT, with lower invasiveness, faster recanalization, and the possibility to immediately treat the underlying lesions, with a lower rate of bleeding complications and no need for intensive care unit stay. Currently, several mechanical thrombectomy devices are offered as an alternative therapy and can be divided into pure rotational MATH systems and rheolytic thrombectomy devices. The only pure rotational MATH device currently available on the market is the Rotarex S device. We aimed to review contemporary clinical data regarding the safety, efficacy, and outcomes of MATH therapy using Rotarex S catheter in acute and subacute thrombus-containing arterial lesions of lower limbs. Future perspectives of Rotarex S MATH treatment and cost-effectiveness of its routine use will be also discussed.

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Section: Rotarex S "Math" Vs Thrombolysismentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Percutaneous Rotational Mechanical Atherectomy Plus Thrombectomy Using Rotarex S Device in Patients With Acute and Subacute Lower Limb Ischemia: A Review of Safety, Efficacy, and Outcomes

Loffroy¹,

Falvo²,

Galland³

et al. 2020

Front. Cardiovasc. Med.

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“…17 The results of MT might be improved with IIb/IIIa inhibitors 34 probably because complete retrieval of thrombus can hardly be achieved with MT alone. 35 Mechanical thrombectomy has been tested in peripheral arterial 36 or pulmonary interventions 37 although it is not currently available for coronary procedures. Our study support that selective MT could be based on the DDTA score; moreover, the estimation of in-hospital outcomes could be accurately assessed by the DDTA score and Zwolle risk scores together.…”

Section: Ddta Score and Other Outcomesmentioning

confidence: 99%

Multicenter and all‐comers validation of a score to select patients for manual thrombectomy, the DDTA score

Cordero

Cid-Álvarez

Alegría

et al. 2021

Cathet Cardio Intervent

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Background: Routine manual thrombectomy (MT) is not recommended in primary percutaneous coronary intervention (P-PCI) but it is performed in many procedures.The objective of our study was validating the DDTA score, designed for selecting patients who benefit most from MT.Methods: Observational and multicenter study of all consecutive patients undergoing P-PCI in five institutions. Results were compared with the design cohort and the performance of the DDTA was analyzed in all patients. Primary end-point of the analyses was TIMI 3 after MT; secondary endpoints were final TIMI 3, no-reflow incidence, in-hospital mortality and in-hospital major cardiovascular events (MACE).In-hospital prognosis was assessed by the Zwolle risk score.Results: Three hundred forty patients were included in the validation cohort and no differences were observed as compared to the design cohort (618 patients) except for lower use of MT and higher IIb/IIIa inhibitors or drug-eluting stents. The probability of TIMI 3 after MT decreased as delay to P-PCI was higher. If DDTA score, MT was associated to TIMI 3 after MT (OR: 4.11) and final TIMI 3 (OR: 2.44). There was a linear and continuous relationship between DDTA score and all endpoints. DDTA score ≥ 4 was independently associated to lower no-reflow, in-hospital MACE or mortality. The lowest incidence of in-hospital mortality or MACE was in patients who had DDTA score ≥ 4 and Zwolle risk score 0-3.Conclusions: MT is associated to higher rate of final TIMI3 in patients with the DDTA score ≥ 4. Patients with DDTA score ≥ 4 had lower no-reflow and in-hospital complications.

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“…Важливим є те, що при цьому є можливість видаляти як свіжі тромботичні маси, так і застарілі тромби, що особливо актуально при лікуванні постемболічних оклюзій, коли тромботичні маси фіксуються до інтими артерій. Ротаційна тромбектомія має переваги перед катетер-спрямованим тромболізисом, так як при цьому ризик кровотеч є мінімальним та практично відсутні протипокази [6,7,9,10]. Аспіраційна тромбектомія не дозволяє радикально видаляти тромботичні маси, особливо у випадках застарілих тромбів.…”

Section: вступunclassified

The use of rotational thrombectomy in the treatment of arterial thrombosis

Петрушенко¹,

Khrebtii²,

Skupyi³

et al. 2018

Rep. of Vinnytsia Nation. Med. Univ.

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Rotation thrombectomy is a modern method of treating peripheral arterial disease. To date, there are no randomized studies regarding rotational thrombectomy. We want to share our own results in the treatment of patients with arterial thrombosis in the treatment of 8 patients with arteriosclerosis of the lower extremities, complicated by thrombosis using Rotarex. Patients noted the acute onset of the disease, but were referred to the clinic after 2 weeks since the onset of clinical signs of the disease. All patients underwent ultrasound examination, arteriography of the affected arterial segment. After treatment, all patients underwent control angiography. During the procedure, heparin and clopidogrel were administered. One patient had systemic lupus erythematosus. Patients had thrombosis of the femoro-popliteal arterial segments. All patients had a critical ischemia of the lower extremities. Men were 6, women — 2. 2 (25%) of patients had thrombosis of the stent of the superficial femoral artery. In 8 (100%) cases, rotational thrombectomy with rotary catheter was used. For the procedure, catheters with a diameter of 6F and a length of 110–135 cm were used. During the procedure, a catheter was performed from 3 to 5 passages in the affected segment. Duration of the procedure was 1.5–2 hours. In 6 (75%) cases, after the thrombectomy, ballooning of the affected segment was used with a balloon covered with polytaxel. In 8 (100%) patients, there was a clinical improvement. In 8 (100%) patients, control arteriography showed complete patency of the affected segments of the femoral and popliteal arteries. In 8 patients, ischemia was regressed. Cases of rethrombosis were not observed. Thus, rotation thrombectomy is a modern and effective method of treatment of arterial thrombosis of the femoral and popliteal segment.

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Could mechanical thrombectomy replace thrombolysis in the treatment of acute and subacute limb ischemia?

Cited by 6 publications

References 39 publications

Percutaneous Rotational Mechanical Atherectomy Plus Thrombectomy Using Rotarex S Device in Patients With Acute and Subacute Lower Limb Ischemia: A Review of Safety, Efficacy, and Outcomes

Percutaneous Rotational Mechanical Atherectomy Plus Thrombectomy Using Rotarex S Device in Patients With Acute and Subacute Lower Limb Ischemia: A Review of Safety, Efficacy, and Outcomes

Multicenter and all‐comers validation of a score to select patients for manual thrombectomy, the DDTA score

The use of rotational thrombectomy in the treatment of arterial thrombosis

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