Enhancement of in vitro effectiveness for hydrodynamic thrombectomy devices. Simultaneous high-pressure rt-PA application.

RATIONALE AND OBJECTIVES To determine the efficacy of simultaneous high-pressure recombinant tissue plasminogen activator (rt-PA) application for clot removal and procedure-related peripheral particle embolization for the hydrodynamic thrombectomy devices LF 140 AngioJet (LF 140) and triplelumen Hydrolyser (triple HL) in an in vitro flow model. METHODS Thrombectomy of clots (n = 47) from 5-day-old human blood (8.9-9.7 g) was performed with the LF 140 and the triple HL, each with and without simultaneous rt-PA (9.97-12.59 g) application in a flow model (flow 1 liter/min) made of silicone tubes (7 mm inner tube diameter). All catheters were used according to the manufacturer's recommendations. RESULTS The triple HL revealed no statistically significant performance differences with additional rt-PA. For the LF 140, mean thrombectomy time ranged from 23.5 sec (with rt-PA) to 33.5 sec (P = 0.05). The ratio of peripheral embolus weight to thrombus weight was reduced from 2.12% to 0.46% (rt-PA; P = 0.05). None of the tested devices had an isovolumetric performance; the mean ratio of applied saline to aspirated fluid for the devices were different from one, ranging from 0.89 to 0.92 (rt-PA) for the triple HL and from 0.43 to 0.52 (rt-PA) for the LF 140. No significant differences for remaining thrombus within the tubes were found. CONCLUSIONS Simultaneous rt-PA-enhanced hydrodynamic thrombectomy is feasible in vitro. This combination reduces the time for thrombectomy and procedure-related peripheral particle embolization for the LF 140. No effect could be demonstrated for the triple HL in an in vitro flow model. It remains unclear whether this procedure is effective in vivo. It seems likely that the incidence of fibrinolysis-associated complications may increase in vivo.