1550_Jaffer.pdf

1、Lytics and Thrombectomy Devices:How and When do I Choose and Use?Osman Jaffer,MD.Staff Coronary and Peripheral Interventional Cardiologist:Hartford Health CareCatheter Directed Thrombolysis(CDT)vs.Devices:How Do We Choose?Heterogenous population set Vast array of tools to use Extremely important to

2、involve vascular surgeons Prior to 1950,amputation was mainstay of treatment Fogarty arterial embolectomy catheter developed in 1961 by Dr.Thomas Fogarty Surgical bypassCatheter Directed Thrombolysis(CDT)vs.Devices:How Do We Choose?J Vasc Surg.2013 October;58(4):949956.doi:10.1016/j.jvs.2013.04.036.

3、323 bypass for ALI-5000 for CLIHigher morbidity for-ALI patients(20%vs.12%)Higher limb loss at 1 year(22%vs.10%)Highter mortality at 1 year(21%vs.12%)Catheter Directed Thrombolysis(CDT)vs.Devices:How Do We Choose?Percutaneous options CDT Thrombectomy Devices HybridCatheter Directed Thrombolysis(CDT)

4、vs.Devices:How Do We Choose?Advantages to CDT:Percutaneous TherapyLess invasive Decreases morbidity of surgery Decreases reperfusion injury Identifies lesions that need to be treated Applicable to subacute lesionsAny proven clinical benefit?Catheter Directed Thrombolysis(CDT)vs.Devices:How Do We Cho

5、ose?Endovascular Treatment for ALI:CDTCatheter Directed Thrombolysis(CDT)vs.Devices:How Do We Choose?Endovascular Treatment for ALI:CDTCatheter Directed Thrombolysis(CDT)vs.Devices:How Do We Choose?Endovascular Treatment for ALI:CDTTrial stopped early at only 393 patient recruitment because of hitti

6、ng hard clinical endpoint of safetyMet endpoint in the CDT group vs surgery,primarily driven by ongoing/recurrent ischemiaCatheter Directed Thrombolysis(CDT)vs.Devices:How Do We Choose?Endovascular Treatment for ALI:CDTHowever,in subset data those patients with 150 Angiojet secon