Endovascular revascularization strategies using catheter-based thrombectomy versus conventional catheter-directed thrombolysis for acute limb ischemia

Abstract

Background Acute limb ischemia (ALI) is an important clinical event threatening both life and the affected limbs, but the optimal treatment for ALI remains undefined. The aim of this study was to compare the safety and effectiveness of thrombectomy approaches via either catheter-based thrombectomy (CBT) or catheter-directed thrombolysis (CDT). Methods A total of 98 patients (mean age 69.7 years, 60 male) who underwent endovascular intervention for ALI from January 2015 to July 2019 were included. Of these, 57 were treated with primary CBT via a large-bore catheter, an AngioJet catheter or Rotarex catheter, and/or underwent low-dose CDT, and 41 were treated with primary CDT. The safety and effectiveness of CBT compared to conventional CDT and other various endovascular techniques were evaluated. Results More Rutherford IIb patients were treated with primary CBT (68.4%) than CDT (26.8%; P < .001). Patients who underwent primary CDT achieved a higher technical success rate than those who underwent primary CBT in a shorter procedure time (P < .001), whereas 42.1% of patients who underwent CBT did not need adjunctive CDT. The duration and dosage of adjunctive CDT in the CBT group were significantly decreased compared with those in the primary CDT group (both P < .001), and the CBT group achieved a shorter in-hospital length of stay (P < .001). Subgroup analysis revealed that patients treated with AngioJet and Rotarex catheters achieved slightly lower dosages, shorter CDT durations and shorter in-hospital stay lengths than those treated with large-bore catheters (P > .05). Clinical success was estimated to be achieved in 98.2% of patients who underwent CBT, which is similar to the 97.6% estimated in those who underwent primary CDT (P = 1.000), and this finding was similar among the CBT subgroups. Patients who underwent CBT had a higher procedure-related distal embolization rate and economic cost than those who underwent primary CDT (P < .05), but it had slightly fewer complications than those who underwent primary CDT (P = .059), especially minor complications (P = .036). The freedom from amputation at 6 and 12 months for CBT and CDT was assessed (93.0% vs 90.2% respectively, P = .625; 89.5% vs 82.9%, respectively, P = .34,). Comparable limb salvage was found for different techniques of large bore catheters, AngioJet catheters and Rotarex catheters. The Kaplan-Meier table analysis also showed similar limb salvage rates between groups. Conclusions Endovascular treatment of ALI with the use of catheter-based therapies is an effective modality that can reduce the requirement for thrombolysis, with expected reductions in hemorrhagic complications, but at the risk of remediable distal emboli and increased economic cost. It has a similar clinical outcome to conventional CDT alone. Different CBT techniques have comparable efficacy but different adverse event profiles.

Novel Application of Large Bore Aspiration in the Treatment of COVID-19 Associated Acute Limb Ischemia Using the Penumbra CAT 12 Lightning Aspiration System

“…Endovascular approach has proven safety and efficacy when used by experienced operators for treatment of ALI in the appropriate population [10] . We report the first in human use of Penumbra CAT 12 mechanical thrombectomy catheter to perform aspiration thrombectomy in the peripheral arterial space.…”

Endovascular Therapies Using Catheter-Based Thrombectomy or Catheter-Directed Thrombolysis for Acute Non-Cancer Associated Inferior Vena Cava Thrombosis: A Retrospective Cohort Study

“…Future mechanical thrombectomy devices that can potentially treat patients with a higher bleeding risk and minimize expenditures through avoidance of fibrinolytic agents should be considered. 8 Another, the drawbacks of selective basis may exist, as some patients were transferred from other hospitals due to limited medical conditions, and oncological patients were excluded. A third, this study is limited to an early short-range observation, and some PTS may present beyond a longer follow-up.…”

“…If under 50% thrombus removal rate was observed at post -CBTs or if patients underwent CDT alone, a dose-reduced thrombolytic therapy of rt-PA was administered, as previously described. 8,9 Balloon angioplasty and/or stent placement were used for lesions that caused over 50% diameter narrowing of the iliocaval vein, robust collateral filling, and/or a mean pressure gradient of more than 2 mmHg. 1,7,8 At the end of LMWH, combined oral warfarin or directed rivaroxaban therapies were used for anticoagulation for at least 6 months.…”

“…Symptom improvement was assessed by measuring the limb circumference difference at 15 cm above the knee and 10 cm below the knee, as well as using a visual analog scale to assess leg pain pre -treatment and at discharge. 8 The outcomes were evaluated at the 12-month follow-up, including recurrent DVT or death, and the resolution of symptoms was evaluated using the Villalta scale 11 via re-examination or telephone.…”

“…8,9 Balloon angioplasty and/or stent placement were used for lesions that caused over 50% diameter narrowing of the iliocaval vein, robust collateral filling, and/or a mean pressure gradient of more than 2 mmHg. 1,7,8 At the end of LMWH, combined oral warfarin or directed rivaroxaban therapies were used for anticoagulation for at least 6 months. 9 In addition, the use of compression stockings for more than 1 year was recommended.…”