Fibrinolytic therapy of arterial thrombosis in patients with peripheral arterial disease previously treated with endovascular interventions with stent placement

Abstract

Background. Acute in-stent thrombosis can occur in patients with peripheral arterial disease previously treated with endovascular interventions with stent implantation. Local fibrinolysis is an alternative treatment to endarterectomy. This study aims to determine the outcomes of local fibrinolysis in patients with arterial instent thrombosis.
Material and methods. We retrospectively reviewed 27 cases following procedures of local fibrinolysis in patients with diagnosed recent thrombosis of peripheral arteries previously treated with endovascular interventions with stent placement. In 2 patients, in-stent thrombosis was diagnosed within 1 day of stent implantation, while in the other patients thrombosis was observed several or even a dozen months after endovascular procedure. As a fibrinolytic agent we used t-PA (Actylise), which was administered by fibrinolytic catheter localised in the occluded artery. Initial treatment was 5mg bolus of t-PA followed by infusion at a rate of 1–1.5 mg/h. Continuous infusion of therapeutic dose of heparin was maintained. Blood parameters, such as coagulation, blood count, renal function parameters, and electrolytes, were monitored. Duration of infusion ranged from 12 to 120 hours. Angiography was used to assess the final effect of fibrinolysis. We analysed the type and frequency of adverse events and their appearance according to duration of t-PA infusion.
Results. We obtained satisfactory reocclusion of the arteries in 24 patients (88.8%). No complications were noted in 14 patients (48%). We did not observe any severe adverse events such as intracranial bleeding, intestinal bleeding, myocardial infarction, or death. Most of the complications were noted within 24 hours of fibrinolysis.
Conclusions. Local fibrinolytic therapy of in-stent thrombosis with intraarterial infusion of fibrinolytic catheter localised under angiographic control is an effective method of patency restoration. The longer the fibrinolysis, the higher the possibility of adverse events. According to the analysis it is questionable whether or not strict monitoring of blood parameters can decrease the number of potential adverse events.