Mechanical versus chemical thrombolysis: An in vitro differentiation of thrombolytic mechanisms
Mechanical versus chemical thrombolysis: An in vitro differentiation of thrombolytic mechanisms
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DOI：
10.1016/s1051-0443(07)61465-1
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发表时间：
2000-02-01
影响因子：
2.9
通讯作者：
Green, R
中科院分区：
文献类型：
--
作者：
Greenberg, RK;Ouriel, K;Green, R
目的：评估决定再灌注时间、血栓溶解完整性和栓塞可能性的不同溶栓机制，材料和方法：创建模拟动脉血流条件的体外灌注模型，分叉肢体允许连续流过一个通道，并将放射性标记（碘 125）血栓放置在另一个通道的 5 厘米聚四氟乙烯移植物中，三个实验组包括标准连续尿激酶输注、脉冲加压注射生理盐水和类似的尿激酶注射，连续输注 5% 葡萄糖作为对照组，分析回流时间（通过超声流量监测评估）、血栓溶解的完整性（I-125 释放到溶液中）以及产生的栓塞颗粒的数量和大小（通过一系列分级过滤器尺寸检测）。使用加压注射时，两组均明显更快 (P < .001)，90 分钟时对照组中没有出现回流，与动力注射组或对照组相比，使用连续输注尿激酶时血栓溶解的完全性更高 (P < .05)，与动力注射组相比，连续输注尿激酶时产生的栓塞碎片量显着降低 (P < .05)。 .05)，但显着大于对照组 (P < .001)。添加尿激酶后，功率脉冲裂解组中栓塞颗粒的尺寸显着减小 (P < .05)。结论：使用机械方法可以更快地建立回流，但是；通过这种方法，可以实现血栓的不太完全溶解以及更多的栓塞碎片。通过添加溶栓剂可以减小所产生的栓塞颗粒的尺寸。
PURPOSE: To assess differing mechanisms of thrombolysis determining time to reperfusion, completeness of thrombus dissolution, and embolic potential,MATERIALS AND METHODS: An in vitro perfusion model designed to mimic arterial flow conditions was created, Bifurcated limbs allowed continuous flow through one channel and the placement of radiolabeled (iodine-125) thrombus housed in a 5-cm segment of polytetrafluoroethylene graft in the other, The three experimental groups consisted of a standard continuous urokinase infusion, a pulsed pressurized injection of saline, and a similar injection with urokinase, A continuous infusion of 5% dextrose served as a control group, Time to reflow (as assessed with ultrasonic flow monitoring), completeness of thrombus dissolution (I-125 liberated into solution), and the number and size of embolic particles produced (detected by a series of graduated filter sizes) were analyzed,RESULTS: Time to reflow was significantly faster for both groups when pressurized injections were used (P < .001), There was no reflow in the control arm at 90 minutes, Completeness of thrombus dissolution was higher when a continuous infusion of urokinase was used in comparison to either of the power injection groups or the control (P < .05), The amount of embolic debris produced was significantly lower with a continuous infusion of urokinase compared with either of the power lysis groups (P < .05), but significantly greater than the control arm (P < .001). The size of the embolic particles in the power pulsed lysis groups was significantly decreased by the addition of urokinase (P < .05),CONCLUSIONS: Reflow is more rapidly established by the use of mechanical means, However; a less complete dissolution of thrombus in conjunction with a greater amount of embolic debris is achieved with this approach, The size of the embolic particles produced is reduced by the addition of a thrombolytic agent.