What is Arterial Thrombolytic Therapy?

Arterial thrombolytic therapy is the name given to a group of medications that dissolve blood clots. Blood clots form in blood vessels (arteries) for a variety of reasons. One of the most frequent causes is narrowing in the blood vessel. Narrowings occur when fatty cholesterol deposit in the walls of the artery. When blood does not flow smoothly through the narrowed blood vessel, blood clots develop. Clots limit the flow of blood and can cause pain or coldness in an arm or leg.

Receiving a clot dissolving medication will, hopefully, destroy the clot, bring back flow and reduce or eliminate your symptoms.

How Will I Receive The Clot Dissolving Medication?

The medication is given through a small plastic tube that is inserted in your arm or leg. In order to determine if you have a blood clot and where it is located, the blood vessels must first be photographed. The study of the blood vessels (arteries) is called an arteriogram. With the use of x-ray dye, the vessels can be studied to pinpoint the clot. An Interventional Radiologist will perform the procedure in the Radiology Department.

What Can I Expect Before Receiving Thrombolytic Medications?

It is important to speak with your physician before receiving thrombolytic medications. You may be asked to:

• Have blood tests prior to receiving the medication
• Make adjustments in your medications
• Limit food and/or drink for a time prior to the procedure
• Stay in the hospital for several days during and after you receive the medication.

What Can I Expect During Thrombolytic Therapy?

The beginning of therapy involves photographing the blood vessels and locating the clot-- this is the arteriogram portion of the procedure. During the procedure you will need to lie flat. You will be covered with a sterile sheet and an area on your arm or leg will be cleansed with a liquid soap. An intravenous (small needle) will be inserted into your arm to provide you with fluids and/or medications if needed.

A small plastic tube will be placed in your groin or arm. A numbing medication will be used on this area to prevent discomfort. The medication will sting for a few seconds and then will make the area numb. Aside from this sensation, the procedure is relatively painless. The Radiologist will place a small plastic tube through the numbed skin into the artery, inject x-ray dye and photograph the clot.

Once the clot is located, the medication will be administered through a special machine, which delivers the medication at a precise rate. The plastic tube in your arm or leg will allow the medication to flow to the clot. While the medication infuses you will need to keep the area where the tube is located straight to prevent kinking of the tube.

Nursing Care and Management During Thrombolytic Therapy

Once the medication is started, you will be transferred to a nursing unit. Your heart rate, blood pressure, tube site and medication rate will be monitored closely. You will also be observed for signs of bleeding.

The medication may need to be administered over several hours or even several days in order to dissolve the clot. You may periodically need to return to the x-ray department for more photographs of the blood vessels to determine your progress.

When the clot is dissolved, or when no further improvement can be obtained, the medication will be stopped and the plastic tube in your arm or leg will be removed. Pressure will be applied to the site until bleeding is controlled.

Considerations after Thrombolytic Therapy

Your movement may be restricted during the infusion of the medication. It is important to take deep breaths frequently, both during and after therapy, due to your decreased activity. After removal of the plastic tube, you should keep your arm or leg straight for several hours. You may be placed on special medications to help prevent clot formation. Consult your physician for instructions. You may require other procedures to correct the narrowings in the blood vessels which caused the clot. Your physician will discuss these with you if they are needed.

What is the endovascular embolization procedure like?

The patient may either already be in the hospital or may arrive the night before or morning of the embolization. The patient will be asked not to eat anything after midnight the night before the procedure. Aneurysm embolization procedures can be performed under general anesthesia or under light sedation. The procedure may last only a few hours, or it may last the greater part of a day. This is often not predictable, and family members should not be frightened simply because a case takes longer than expected.

After the procedure is completed, the patient will need to remain still, lying flat on his/her back for up to eight hours. This rest period allows the needle hole in the groin artery to heal. The patient usually remains under observation in the hospital for at least one more day before returning home. Longer stays are common, depending on the patient's condition.

Will all symptoms go away after the aneurysm is embolized? Will any other visits to the doctor be necessary?

It is important to understand that the embolization procedure does not repair areas of brain already injured by a stroke. It is performed to prevent the aneurysm from causing injury to other areas in the future. A patient who has had a severe stroke may continue to need intensive medical care even after the aneurysm has been embolized. Most patients will also need to return for follow-up arteriogram, usually performed several months after the embolization procedure. This is to make sure that the aneurysm is completely embolized and has not grown larger. Occasionally, these follow-up studies show that a second or third embolization procedure is needed to completely cure the aneurysm.

How do you get aneurysms? Are they hereditary? Should family members be tested?

Aneurysms are usually the result of abnormal blood flow patterns within an artery. As the blood pulsates against an area of the vessel wall, the wall begins to bulge outwards. This process usually takes years, and aneurysms in children are extremely rare. High blood pressure can contribute to the formation of some aneurysms. Diseases which weaken arterial walls are uncommon causes of aneurysms, The majority of aneurysms, however, are isolated problems. They are not due to any disease, they are not hereditary and family members are not at increased risk.