The results of quantitative evaluation of the angiograms according to the angiographic severity index are given in Table 3. Its decrease prefragmentation to postfragmentation was highly significant (p < 0.001). According to the definition of fragmentation success, three cases were refractory to this therapy (No. 3,6,10), which is equal to a success rate of 70%. The overall mean percentage of recanalization by fragmentation was 29.2 ± 14.0% (range, 11 to 57%). The mean percentage exclusively of the seven successful cases accounted for 36.0 ± 10.0% (range, 25 to 57%).
In 2 of 10 patients, thrombolytic therapy was absolutely contraindicated (Table 4). www.canadian-familypharmacy.com read Additional thrombolysis with plasminogen activator (rt-PA, Actilyse; Thomae; Biberach/Riss, Germany) was performed in the remaining eight cases (five relative contraindications, three without contraindications, Table 4). The eight patients received a mean dose of 63 ± 25 mg. Only in two of eight patients was the approved maximum dose (100 mg) administered. Bleeding complications did not occur. In a patient with heparin-induced thrombocytopenia syndrome and a large, consistent central embolus (No. 3), thrombolysis with 60 mg rt-PA failed to achieve any improvement. After subsequent fragmentation, which showed only marginal improvement, thrombolysis was continued with urokinase (Rheotromb; Curasan; Kleinostheim, Germany) for 3 days.
There were no complications related to angiography or to the fragmentation procedure. One patient (No. 9), who underwent repeated cardiopulmonary resuscitation, died from right heart failure 1 h after fragmentation, despite a successful partial recanalization. This was classified as a medical adverse event. In the other nine patients, no adverse events happened within the 48-h follow-up interval (Table 5). Circulatory restitution at 48 h was achieved in five patients, and in a further patient (No. 1), considering that the pulmonary hypertension was chronic (Table 5). This is equal to a 48-h treatment success rate of 60%. The remaining cases did not fulfill the criteria of shock index < 1 (No. 7,9,10), mean pulmonary arterial pressure < 25 mm Hg (No. 3,7,9), and normalized systemic arterial BP (No. 9,10).