Catheter Directed Thrombolysis

What will happen?

After the hospital admission (often directly to ICU), you will be brought to the Interventional Radiology Suite where the interventional radiologist (a doctor specially trained in that procedure) and radiographer will explain the procedure and answer your questions. The study usually takes 60 to 90 minutes but may take much longer depending on the severity of vascular disease. After completion, you will be transferred to ICU for the treatment and brought back to Radiology Suite for follow-up — usually after 18-24 hours.

Do I need any test before the procedure?

You will be asked to have following blood tests:

Urea & electrolytes — to assess if your kidneys will tolerate contrast. PI/FIT/Platelets — to assess the risk of post procedural bleeding.You should discuss any allergy history (particularly to Iodine) with the radiologist prior to booking the procedure.

The catheter placement procedure

The procedure starts as general angiography.

Under the X-ray guidance the doctor will pass a guide-wire into the clotted vessel and over it, advance a catheter into the best position for the infusion of thrombolytic agent. The catheter will be secured and connected to a special machine, which will deliver medication at precise rate (prescribed by the vascular surgeon). You will then be transferred to ICU and specially trained nurse will monitor infusion as well as your vital signs. Duration of treatment will depend on the maturity of clot but is usually not longer than 48 hours. You will have at least one control angiography through the catheter after which the radiologist and vascular surgeon will decide if your vessel will need any additional treatment (angioplasty or stenting).

Does it hurt?

During the catheter placement similar to angiography

Clot dissolving process is sometimes followed by moderate pain, which is easily controlled by per oral or IV painkillers

What are the additional risks?

Whenever thrombolytic agent is used, there is a risk of bleeding somewhere else in your body — often happening at the site of tube insertion. The most serious complication is bleeding in your brain. The other complications are the same as for general angiography.

When will I get my results?

In most cases the radiologist will be able to discuss the results with you and your family immediately after the procedure

When will I resume my normal activities?

This will depend on several factors — particularly how you tolerated the infusion and if any other intervention or operation is needed. The radiologist and attending surgeon will discuss the options with you.

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