What is thrombolytic therapy?

Thrombolysis is the treatment to break up abnormal blood clots that are restricting blood flow.Thrombolytic therapy dissolves these blood clots using various medications administered directly into the clot through a catheter. Radiologic thrombolysis can greatly improve blood flow and reduce or eliminate the related symptoms and effects without the need for more invasive surgery.

What are some common uses of the procedure?

Whenever blood does not flow smoothly, clots can develop, slowing or blocking the blood supply to an organ or extremity. The blockage, known as a thrombosis, may cause no noticeable symptoms or it may cause pain, numbness, coldness, tingling or swelling in an arm or leg, or poor function in an affected organ. Tissue deprived of adequate circulation can be seriously damaged.

How should I prepare for this procedure?

You will have blood drawn to learn how well your kidneys are functioning and whether your blood clots normally. Staff also will advise you if there is to be a change in your medication schedule, especially for medications that thin the blood (anticoagulants). You will be admitted to the hospital the day before the procedure or the morning of the procedure and will be examined by the radiologist before the procedure begins.

How is the procedure performed?

A sedative is injected through an IV line to relax you, though at times a general anesthetic is given instead. The interventional radiologist will then find an appropriate blood vessel, usually in the groin, arm or neck, and numb the area with a local anesthetic. A thin catheter is passed through a very small incision into a blood vessel and, guided by x-rays, is maneuvered to the area of poor circulation. Contrast material then is injected and a series of x-rays are taken to pinpoint the location of the clot. The interventional radiologist will review the images to determine whether the clot would be best treated by a clot-dissolving medication, by breaking it up with a mechanical device or both.

The catheter is advanced through the blood vessels of the body to the vessel that has the clot. If the clot will be treated with medication, the catheter is left in place, connected to a special machine that delivers the medication at a precise rate. The clot-dissolving medications are delivered through the catheter over several hours.

What will I experience during the procedure?

The IV sedative will make you feel relaxed and sleepy and you may nod off for brief periods, but generally will remain awake throughout the procedure. You may feel slight pressure when the catheter is inserted but no serious discomfort. As the contrast material passes through your body, you may get a warm feeling. However, this soon passes.

To avoid disrupting the catheter’s precise placement, your movement will be restricted during the time the clot-dissolving medication is being administered. When the clot is removed, or when no further improvement can be achieved, the medication will be stopped and the catheter removed. You will be required to lie quietly for some time afterward, usually with pressure applied to the entry site to prevent bleeding.

Many patients experience some side effects after thrombolysis. Pain is the most common and can readily be controlled by oral or intravenous medication. Most patients can resume their normal activities within a week or two. You may or may not remember some things about the procedure.

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