#thrombolysis

About AIVR.

Thrombolysis, also known as thrombolytic therapy, is a medical treatment used to dissolve dangerous blood clots in blood vessels. This therapy uses special medications—often called “clot-busting drugs”—to restore normal blood flow and prevent serious damage to organs and tissues.

It is commonly used in emergency situations such as heart attacks, ischemic strokes, pulmonary embolism, and deep vein thrombosis (DVT), where blood clots block arteries or veins and restrict blood circulation. Rapid treatment is critical because early clot removal significantly improves patient outcomes and reduces the risk of long-term disability.

Thrombolytic drugs work by breaking down fibrin, a key protein that forms the structure of blood clots. Medications such as alteplase, tenecteplase, streptokinase, and urokinase are widely used to dissolve clots and restore blood flow.

With the rising prevalence of cardiovascular diseases and increasing awareness of emergency stroke and heart attack treatments, the demand for thrombolysis therapies continues to grow. Advances in biotechnology and improved drug formulations are also enhancing the safety and effectiveness of these life-saving treatments.

The Evolution of Clot Removal Technology Clot formation inside blood vessels that supply the lungs, brain or other vital organs can have life-threatening consequences if not treated promptly and effectively. For decades, pharmacological interventions involving anticoagulant and thrombolytic drugs were the primary treatment approaches. However, these systemic therapies are not always fully successful in dissolving or removing clots, and carry risks of hemorrhage. In the past two decades, medical device technologies for minimally invasive mechanical removal or dissolution of clots have rapidly advanced. These clot management devices have revolutionized the treatment of pulmonary embolism and cerebral venous thrombosis. Catheter-Based Clot Retrieval One of the earliest and most widely used clot extraction approaches involves catheter-delivered retrievable stent designs. These devices utilize a nitinol mesh cylindrical structure that can be collapsed inside a delivery catheter and expanded upon deployment within a clot. Barbera first described use of the Tulip venous filter for retrieval of acute iliofemoral deep vein thrombosis in 1994. Building upon this, devices such as the Retrieval Inferior Vena Cava Filter and Denali Filters were developed specifically for clot capture and removal from larger veins. For pulmonary embolism, retrievable expandable stent designs like the Tulip Vena Cava Filter, Recovery Filter and OptEase Filter allowed for minimally invasive extraction of clots from the pulmonary arteries. A major advancement was the introduction of stent retrievers optimized forremoving thromboembolic occlusions from intracranial blood vessels. The Merci Retriever was among the earliest such devices approved by the FDA in 2004 for mechanical thrombectomy in acute ischemic stroke. Second generation retrievable stents like the Solitaire and Trevo devices featured superior design and deliverability profiles enabling higher recanalization rates. Recent studies support use of stent retrievers as the first-line treatment for large vessel occlusions in the anterior cerebral circulation. Ongoing research aims to expand the utility of Clot Management Devices catether-deployed devices to more distal vessel occlusions. Ultrasound-Accelerated Thrombolysis While pharmacologically-assisted thrombolysis remains a mainstay for selected patients, treatment times can be prolonged. Ultrasound energy has shown promise in accelerating fibrinolysis through mechanical fracture of clot structure and increased uptake of thrombolytic drugs. Devices generating low-frequency, high-intensity ultrasound via an intravascular catheter have been evaluated. Early studies demonstrated the EKOS System's ability to rapidly dissolve pulmonary emboli when infusing alteplase, halving treatment duration versus pharmacological therapy alone. The Sonolysis Thrombolytic Infusion Catheter was developed for treating iliofemoral deep vein thrombosis, administering ultrasound plus alteplase directly within the thrombus. More recently, the EkoSonic Endovascular System received FDA clearance for use in acute massive and submassive pulmonary embolism. Its small-profile ultrasound emitter works in tandem with front-line thrombolytic drugs to rapidly recanalize blood clots. Ongoing research also investigates combining intravascular ultrasound with novel thrombolytic drug formulations like microbubbles or plasminogen activators to potentially enhance and target fibrinolysis. Get more insights on Clot Management Devices

About Author:

A healthy heart pumps healthy – and if there is a problem with your heart rate or rhythm, that could be the first symptom related to any heart disease and the general state of your health. Your doctor may order several medical tests to help determine your heart condition and the best way to treat it. The outcome of the trial assists your doctor in providing you with a suitable treatment plan. Usually, you’ll need more than just one test to analyze your condition effectively. Some of these tests are discussed beneath.

Electrocardiogram (ECG or EKG): A tracing or measuring of the Heart’s electrical activity. Electrocardiograms can help diagnose numerous heart conditions. It is a simple and painless test.

Echocardiogram: An ultrasound of the Heart. An echocardiogram directly shows any kind of problems with the heart muscle’s pumping capacity and heart valves. It is helpful for the cardiologist to know how nicely your Heart’s chambers and valves work.

Cardiac stress test: The Heart is activated to pump to near-maximum capacity by employing a treadmill or medications. This may identify people with coronary artery disorder in a controlled clinical environment.

Cardiac catheterization: A catheter, a long, thin tube, is inserted into the femoral artery in the groin, neck, or arm and threaded into the coronary arterial blood vessels. A health care professional can then view X-ray graphics of the coronary arteries or any blockages and execute stenting or other procedures.

Holter monitor: If a doctor suspects an arrhythmia, a battery-operated portable device, which monitors heart activity called a Holter monitor, is attached to your skin. It records the Heart’s rhythm continuously for a 24 to 48-hour period.

Cardiac computerized tomography (CT) scan: This test is often utilized to check for heart issues. In a cardiac CT scan, the patient is made to lay down on a table inside a doughnut-shaped machine. An X-ray tube inside the machine revolves around your body and gathers your Heart and chest images.

Cardiac magnetic resonance imaging (MRI): For this specific test, the patient lies on a table inside a long tube-like machine that produces a magnetic field. The magnetic field has photographs to help your medical professional evaluate the heart condition.

Procedures and treatments: endeavor to lower your signs and symptoms, cease your heart ailment from getting any worse, help your heart rate resume normal, and allow you to dwell in a healthy, pleasant life. These could range from lifestyle and diet changes to open-heart surgery. Your doctor will advise the most qualified treatment plan for you after completing tests, reviewing your outcomes, and diagnosing your condition. Depending on the intensity of your heart condition, you may need more than one procedure or treatment.

Physical exercise: Routine workout is essential for heart health and other heart conditions. Speak to your doctor before starting a workout program if you have heart issues.

Angioplasty: At cardiac catheterization, a cardiologist inflates a balloon inside a narrowed or clogged coronary artery to expand the artery. A stent is often then positioned to keep the artery open.

Percutaneous coronary intervention (PCI): Medical professionals often know Angioplasty as PCI or PTCA (percutaneous transluminal coronary angioplasty). Percutaneous coronary intervention (PCI) is a non-surgical way of treating clogged coronary artery disease, together with unstable angina, acute myocardial infarction (MI), as well as multivessel coronary artery disease (CAD).

Coronary artery stenting: At the time of cardiac catheterization, a doctor expands a wire metal stent inside a narrowed or obstructed coronary artery to open up the region. This lets blood circulation better and can halt a myocardial infarction or relieve angina (chest pain).

Thrombolysis: “Clot-busting” medications injected into the blood vessels can dissolve a blood clot triggering a heart attack. Thrombolysis is generally carried out if stenting is not attainable. Thus thrombolytic therapy dissolves damaging clots in blood vessels, improves blood flow, and prevents harm to tissues and organs.

Lipid-lowering agents: Statins and other cholesterol (lipid) reducing medicines reduce the risk for heart attack in high-risk individuals. Examples include atorvastatin, Fluvastatin, lovastatin, pita vastatin, pravastatin, rosuvastatin, and simvastatin.

Diuretics: Typically known as water pills, diuretics raise urination and fluid loss. This minimizes blood volume, improving symptoms of heart failure.

Beta-blockers: These medications lessen the strain on the Heart and lower heart rate. Beta-blockers are recommended for many heart ailments, including heart failure and arrhythmias.

Angiotensin: converting enzyme inhibitors (ACE inhibitors) are high blood pressure medicines that broaden or dilate the blood vessels to enhance the amount of blood the heart pumps and lower blood pressure.

Aspirin: This highly effective medical aid prevents blood clots, the cause of heart attacks. Many people who have had heart assaults should take aspirin.

Clopidogrel (Plavix): A clot-preventing medication that inhibits platelets from sticking together to form clots. Clopidogrel is particularly vital for many people who have had stents positioned.

Antiarrhythmic medications: Several medications help regulate the Heart’s rate and electrical rhythm— these assist in preventing or manipulating arrhythmias.

AED (automated external defibrillator): If someone has a sudden cardiac event, an AED can be used to measure the heart rhythm and transmit an electrical shock to the Heart if required.

ICD (Implantable cardioverter-defibrillator): If a doctor suspects you are at an increased risk for life-threatening arrhythmia, an implantable cardioverter-defibrillator may be surgically implanted to monitor your heart rhythm and transmit an electrical shock to the Heart if required.

Pacemaker: A pacemaker is often implanted to retain a stable heart rate. A pacemaker transmits electrical impulses to the Heart when necessary to help it beat effectively.

Authored by Cenac Arnaud*

At Sikasso hospital (Mali), the authors report a case of severe pulmonary embolism with the presence of voluminous thrombus in the right heart cavities. Echocardiography rapidly demonstrated the presence of right intracardiac thrombus. Thrombolysis by streptokinase, immediately performed, resulted in clinical healing. Clinical cure of a thrombus of right heart cavities with streptokinase. Importance of echocardiography in the urgent diagnosis.

Read more...FullText

For More Articles in Online Journal of Cardiology Research & Reports please clickon https://irispublishers.com/ojcr/index.php

For More Open Access Journals in Iris Publishers please click on https://irispublishers.com/journals.php

Who requires this procedure ?

This procedure is indicated for patients who develop a clot in the vessels of lower limbs carrying to the muscles of thigh and leg. Commonly seen in diabetics and long-term smokers.

What is the underlying problem?

The underlying disease is a block in the vessels of the lower limb, thereby reducing the blood supply and oxygen yield to the muscles.

What are the consequences of postponing / worst complication if left untreated?

Unless treated at the right time the patients may eventually land up in amputation and thus a poor quality of life.

How is it diagnosed?

Diagnosis requires a CT Angiogram, which is also used to plan the procedure and prognosticate the outcome.

What are the steps of procedure?

JC: Kicking against the prick: Systematic Review of stroke thrombolysis

I think it’s probably fair to say that stroke physicians and emergency physicians disagree about the utility of thrombolysis in acute ischaemic stroke. They love it, probably because of its occasionally amazing effects in restoring an apparently dense hemiplegia with aphasia to almost normality. We hate it, because we see the effects of symptomatic intracranial haemorrhage and the early deaths…