CASE STUDY
Geoffrey S. Ferguson, MD
Evergreen Hospital Medical Center, Kirkland, WA
EKOS® vs. CDT, a side-by-side comparison: Complete
aortoiliac occlusion treated with bilateral lytic infusion
Patient History
– 82 year-old male with acute onset of numbness and weakness in both legs
while in dental chair
– Physical examination: cyanosis and paresis with no palpable pulse in lower
extremities bilaterally
– Duplex ultrasound: a doppler silent distal aorta from superior mesenteric
artery (SMA) inferiorly and no flow in both left and right common iliac arteries
– Angiography: complete occlusion of abdominal aorta at and distal to level of
bifurcation (Fig. 1), with scant collateral flow from inferior mesenteric artery to
internal iliacs (Fig. 2)
Figure 1. Pre-procedural
angiography
Treatment
Bilateral tPA infusion by EKOS® on left side and CDT on right
– EKOS® device (18cm length, 106cm working length) placed in distal aorta
extending into left iliac (Fig. 3)
– A sidehole infusion catheter (5F, 20cm length, Uni*Fuse,™ AngioDynamics®)
placed at the same level extending into right iliac (Fig. 3)
– rt-PA infused at 0.5 mg/hr/catheter for 4 hrs, reduced to 0.25 mg/hr/catheter
for 19 hours (total 23hr infusion)
– Heparin administered with a target PTT of 40-60 seconds
Initial Results
Figure 2.Pre-procedural
angiography
EKOS
EKOS
CDT
CDT
Figure 3. Catheter placement for
therapy
After initial rt-PA infusion by EKOS® on left, CDT on right
– Thrombus completely resolved by EKOS®, but significant occlusion
remained following CDT (Fig.4)
Figure 4. Complete clearance on the left (by
EKOS®), but poor recanalization on the right (by
CDT).
Continuing Treatment and Final Results
rt-PA infusion by EKOS® switched to the right side, CDT to the left
– Continued overnight infusion at same dose
– Complete lysis achieved on the right side with excellent flow observed
proximal and distal to bifurcation bilaterally (Fig. 5)
– Underlying bilateral common iliac stenoses revealed and treated with 7 x
40 mm balloon expandable stents (Fig. 6)
– Patient discharged 1 day post-procedure, ambulating without difficulty, no
weakness or numbness, and no evidence of distal embolization
Switched
to EKOS
Switched
to CDT
Figure 5. Complete clearance achieved on right
side after switching to EKOS®.
Conclusion
– EKOS® therapy resulted in complete thrombus resolution not achievable
by CDT in patient
– Discrepancy between arterial duplex and angiography was attributed to
the nearly but not completely static aortic flow below SMA
Figure 6. Completion
angiography
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thrombolytics, into the vasculature for the treatment of pulmonary embolism; the controlled and selective infusion of physician-specified fluids, including thrombolytics, into the peripheral
vasculature; and the infusion of solutions into the pulmonary arteries. Instructions for Use, including warnings, precautions, potential complications, and contraindications can be found at
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