IMMEDIATE AND EARLY FOLLOW-UP RESULTS OF PULSE-SPRAY THROMBOLYSIS IN PATIENTS WITH PERIPHERAL ISCHEMIA

Pulse spray thrombolysis is a technique of accelerated peripheral thro mbolysis which has been evaluated in 38 patients, 29 with threatened l imb viability and nine with a viable but critically ischaemic limb. Th e median length of occlusion was 26.5 (range 3-65) cm. The lytic agent used was recombinant tissue plasminogen activator (rtPA), injected ma nually via a pulse spray catheter at a concentration of 0.33 mg/ml and a bolus size of 0.2 ml. The median total dose of rtPA was 18 (range 5 -35) mg. Patency and flow were completely restored in 34 of 38 patient s and clinical success at 30 days was maintained in 27 of 38. The medi an lysis time was 120 (range 35-1125) min, compared with a median dura tion of 1545 (range 42-5760) min in 120 consecutive patients previousl y treated with conventional low-dose infusion thrombolysis using rtPA. This represents a 12-fold reduction in lysis time (P < 0.001). The ov erall estimated cumulative limb salvage rate for the 38 patients who e ntered the study was 84 per cent and the cumulative patency rate for t he 34 patients in whom patency was restored was 74 per cent at 18 mont hs follow-up. Pulse spray thrombolysis rapidly restores patency with g ood limb salvage at 30 days; the benefit is sustained even in patients with limbs at immediate risk of irreversible ischaemic injury who are not considered suitable for conventional thrombolysis.