Know the Facts About Thrombolysis

Catheter-directed Thrombolytic Therapy is a minimally invasive endovascular treatment that uses x-ray imaging and a catheter (small tube) to guide the delivery of a specific medication to the site of the blood clot. The medication dissolves the blockage allowing for improved blood flow, preventing damage to tissues and organs. These clots typically occur in the veins or arteries of arms, legs or the pelvis.

Who should not have Thrombolytic Therapy?

Thrombolytics may be contraindicated if you:

  • Are at risk for increased bleeding (bleeding ulcers)
  • Had recent surgery
  • Are pregnant or breastfeeding
  • Are currently using oral anticoagulants
  • Have had any prior intracranial hemorrhage (brain bleed), brain tumor or head trauma
  • Have had a stroke within the past three months
  • Have uncontrolled high blood pressure

The Procedure

You will be given medication to keep you comfortable during the procedure. Your vascular surgeon will numb the treatment area and through a puncture in your skin, a thin plastic tube (catheter) is inserted into a vein or artery (typically in your groin, neck or behind the knee). Once inserted, X-ray images help the surgeon guide the catheter to the clot's location. To treat the clot with medication, the physician leaves the catheter in place and connects it to a machine that delivers the medication at a precise rate. Clot-dissolving medication is delivered through the catheter over several hours to a few days. It may take up to 48-72 hours for the clot to dissolve (although most clots dissolve within 24 hours). When the procedure is complete, the doctor will remove the catheter and apply pressure to stop any bleeding. Sometimes, your doctor may use a closure device to seal the small hole in the artery.

In some cases, a stent (a small cage) may need to be placed where the clot was to help support the walls of the vein or artery.

Barring any condition that would make it unsafe, anticoagulants (blood thinners) are given after the procedure. You may be on these for three-to-six months or longer, if necessary.

Risk Factors & Complications

  • Bleeding
  • Blood clot moving to another area of your body
  • Allergic reaction to the medication or dye
  • Kidney damage from the dye
  • Damage to the blood vessel

Your practitioner will review possible risk factors and complications with you before you have the procedure. You will be asked to sign a consent form stating that you understand the procedure, the risks and any potential complications.

When to call your provider after the procedure

  • Chest pain
  • Warmth or drainage from the catheter site or worsening pain
  • Swelling at the catheter site
  • Recurrence of the initial symptoms
  • Nausea or vomiting that continues to worsen

Why Stony Brook?

Our highly trained professionals can detect most clots with ultrasound. In more complex situations, advanced imaging with high-quality CT scanning is available. If surgery is required, our vascular surgeons are experts in treating potentially life- or limb-threatening blood clots in difficult-to-reach areas.

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