OCCLUDED PERIPHERAL ARTERIES AND BYPASS GRAFTS - LYTIC STAGNATION AS AN END-POINT FOR PULSE-SPRAY PHARMACOMECHANICAL THROMBOLYSIS

Angiographic demonstration of luminal narrowing during pulse-spray pha rmacomechanical thrombolysis (PSPMT) may reflect residual lysable clot , organized thrombus, platelet-rich clot, atherosclerosis, neointimal hyperplasia, or functional narrowing. The authors evaluated the effica cy and safety of lytic stagnation (initial rapid lysis followed by ins ubstantial further lysis with additional treatment) as an end point fo r PSPMT. Lytic stagnation was evaluated with serial angiography in 16 arterial and five bypass graft occlusions. Substantial lysis occurred after administration of mean doses of 512,000 units 182,000 of urokina se or 5.3 mg +/- 2.0 of tissue-type plasminogen activator. Additional treatment with either of those agents produced minimal or no further c hange in the appearance of residual disease. Recanalization was succes sful in all patients after angioplasty. Distal emboli were noted in fo ur cases, in three of which angioplasty of large intraluminal filling defects has been performed. The authors conclude that lytic stagnation is a reliable and safe end point for PSPMT in the absence of large in traluminal filling defects.