Comparison of AngioJet Rheolytic Pharmacomechanical Thrombectomy versus AngioJet Rheolytic Thrombectomy in a Porcine Peripheral Arterial Model |
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Authors: | Peter H Lin Firas F Mussa Nasim Hedayati Joseph J Naoum Wei Zhou Qizhi Yao Panagiotis Kougias Hosam F El Sayed Changyi Chen |
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Institution: | (1) Michael E. DeBakey Department of Surgery, Division of Vascular Surgery & Endovascular Therapy, Baylor College of Medicine, VAMC 112, 2002 Holcomb Boulevard, Houston, Texas 77030, USA |
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Abstract: | Introduction Rheolytic thrombectomy using the AngioJet catheter for arterial thrombosis has been shown to be effective in restoring blood
flow. Additional infusion of thrombolytic agents via the AngioJet catheter results in combined rheolytic pharmacomechanical
thrombolysis (PMT), which further enhances thrombectomy efficacy. However, the histologic response to rheolytic PMT therapy
remains unclear. This study compares the acute and chronic vessel wall response and hemolysis due to conventional AngioJet
rheolytic thrombectomy (RT) and AngioJet PMT in the porcine peripheral arterial model.
Methods A total of 19 juvenile pigs were divided into acute and chronic groups. In the acute group (n = 6), bilateral common carotid, femoral, and iliac arteries ranging from 3 to 6 mm in diameter were randomized to the control
RT group or to PMT therapy. Vessels were analyzed 4 days following interventions. In the chronic group (n = 5), bilateral common carotid, femoral, and iliac arteries ranging from 3 to 6 mm in diameter were randomized to the control
RT group or to PMT therapy. Vessels were analyzed at 30 days following interventions. Hemolytic evaluation was performed in
additional eight pigs, which were randomized to either RT or PMT intervention.
Results In the acute group, similar histologic injury grades were noted between the RT- and PMT-treated femoral and iliac vessels.
Endothelial denudation in the RT and PMT vessels were 43% and 39% (NS), respectively. Vessels with intact internal elastic
lamina (IEL) in the RT and PMT groups were 54% and 57% (NS), respectively. In vessels < 4 mm in diameter, fractured IEL in
the AT and PMT groups occurred in 23% and 27% (NS), respectively. The degrees of smooth muscle cell (SMC) loss were similar
for the RT- and PMT-treated vessels (45% and 40%, respectively; NS). In the chronic group, no differences were seen between
the RT and PMT groups with respect to endothelial denudation, IEL fracture rate, or SMC loss. Similar degrees of medial thickening
or intimal hyperplasia were noted in the RT and PMT groups (49% and 43%, respectively; NS). No difference in hemolytic effect
was noted in the treatment groups.
Conclusions AngioJet rheolytic pharmacomechanical thrombectomy treatment incurs an equivalent safety profile in medium-caliber peripheral
arteries when compared to rheolytic thrombectomy treatment. No difference in hemolytic reaction occurred in either group.
The observed clinical efficacy of rheolytic pharmacomechanical thrombectomy does not result in untoward vessel injury compared
to conventional rheolytic thrombectomy therapy.
This work was presented at the Molecular Surgeon Symposium on Vascular Injury, Repair and Remodeling at the Baylor College
of Medicine, Houston, Texas, May 15 and 16, 2006. The symposium was supported by a grant from the National Institutes of Health
(to C. Chen: R13 HL0836500). |
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