Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2017 Apr 18:11:1233-1241.
doi: 10.2147/DDDT.S131503. eCollection 2017.

A comparative study on endovascular treatment of (sub)acute critical limb ischemia: mechanical thrombectomy vs thrombolysis

Mariya Kronlage  1   2 , Ilka Printz  1 , Britta Vogel  1 , Erwin Blessing  3 , Oliver J Müller  1   2 , Hugo A Katus  1   2 , Christian Erbel  1
Affiliations
Comparative Study

A comparative study on endovascular treatment of (sub)acute critical limb ischemia: mechanical thrombectomy vs thrombolysis

Mariya Kronlage et al. Drug Des Devel Ther. .

Abstract

Objective: The aim of this study was to compare different interventional methods for treatment of (sub)acute limb ischemia upon thrombotic occlusions of the lower extremity in terms of their safety and efficacy in a tertiary hospital setting.

Design: This is a retrospective, single-center study of non-randomized data.

Methods: A total of 202 patients, including 26 critically ill patients, underwent rotational thrombectomy (Rotarex®), local thrombolysis (recombinant tissue plasminogen activator), or combination of both at the University Hospital Heidelberg (2006-2015). The different interventional procedures were compared in terms of overall and amputation-free survival, as well as patency in a 1-year follow-up (Kaplan-Meier analysis).

Results: The study demonstrated a primary revascularization success of >98% in all groups. One year after revascularization, primary and secondary patency after mechanical thrombectomy alone were significantly better in comparison to local thrombolysis or a combination of Rotarex® and lysis (63% and 85%, P<0.05). Overall survival 12 months after intervention reached up to 96% in noncritically ill patients, and amputation-free survival was 94.3% in all three groups. Mean hospitalization duration and rate of major bleedings were significantly increased after thrombolysis compared to Rotarex® (P<0.05).

Conclusion: In patients with (sub)acute limb ischemia, Rotarex® mechanical thrombectomy represents a safe and effective alternative to thrombolysis and is associated with a reduced rate of major bleedings, shorter hospitalization durations, and lower costs.

Keywords: Rotarex®; acute artery occlusion; acute limb ischemia; arterial thrombosis and embolism; mechanical thrombectomy; thrombolysis.

PubMed Disclaimer

Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Kaplan–Meier curves representing overall survival (A and B) and amputation-free survival (C and D) of Rotarex® (blue)-, lysis (green)-, and Rotarex®+lysis (red)-treated patients. The figure is subdivided into a population of noncritically ill (left panel) vs critically ill (right panel) patients. P-values are attributed to the corresponding subfigures.
Figure 2
Figure 2
Twelve-month freedom from target lesion revascularization, re-occlusion, or significant restenosis is presented as Kaplan–Meier primary (A) and secondary patency (B) curves. Rotarex®-treated patients are coded in blue, lysis-treated in green, and Rotarex®+lysis-treated in red. P-values are attributed to the corresponding subfigures.
Figure 3
Figure 3
ABI prior to (pre), immediately after (post), as well as 1, 3, 6, and 12 months after revascularization. Rotarex®-treated patients are identified in blue, lysis-treated patients in green, and Rotarex®+lysis-treated ones in red. Abbreviation: ABI, ankle-brachial index.
See this image and copyright information in PMC

References

    1. Davies MG. Criticial limb ischemia: epidemiology. Methodist Debakey Cardiovasc J. 2012;8(4):10–14. - PMC - PubMed
    1. Baril DT, Patel VI, Judelson DR, et al. Vascular Study Group of New England Outcomes of lower extremity bypass performed for acute limb ischemia. J Vasc Surg. 2013;58(4):949–956. - PMC - PubMed
    1. Norgren L, Hiatt WR, Dormandy JA, Nehler MR, Harris KA, Fowkes FGR, TASC II Working Group Inter-society consensus for the management of peripheral arterial disease (TASC II) Eur J Vasc Endovasc Surg. 2007;33(Suppl 1):S1–S75. - PubMed
    1. Morrison HL. Catheter-directed thrombolysis for acute limb ischemia. Semin Intervent Radiol. 2006;23(3):258–269. - PMC - PubMed
    1. Dotter CT, Rösch J, Seaman AJ. Selective clot lysis with low-dose streptokinase. Radiology. 1974;111(1):31–37. - PubMed

Publication types