Guide Wire Traversal Test: Retrospective Study of Results with Fibrinolytic Therapy

Comparison of thrombolytic therapy of lower-extremity acute, subacute, and chronic arterial occlusions

“…2). This success was also welldocumented by Smith et al [21], in terms of 36 of 51 occlusions that could not initially crossed by a guidewire. This evidence supports the second explanation, that catheter manipulation serves to disrupt the old thrombus fibrin sheath and soften the thrombus, allowing for further advancement of a torquable guidewire through the lesion for subsequent catheter placement within the thrombus.…”

“…This sheath, which makes an older thrombus more organized and partially lysis-resistant, is composed of a platelet-rich thrombotic head and sometimes tail, lines of Zahn, and clot surface membranes [6,20]. This sheath may become broken with guidewire and catheter manipulation; Motarjeme et al [12] and Smith et al [21] recommended breaking the thrombus structure with wires and catheters if needed clinically to macerate the fibrous cap, in order to penetrate the clot. Once the sheath is breached, an underlying thrombus may become exposed to the inherent mechanism of thrombolytics.…”