Plastic Surgery

tension, rupture, and cross-clamp time. In addition to Tissue factor pathway inhibitor (TFPI) is a novel temporary aortic cross-clamping, ischemia-reperfusion agent that binds to tissue factor/VII a complex and fac-(IR) injury to the spinal cord is suspected to play a tor-X a , thereby reducing the effect of tissue factor (TF) role in the development of delayed onset paraplegia. on inflammation and the extrinsic pathway of coagula-Delayed onset paraplegia is manifested when patients tion. We hypothesize that systemic treatment with awaken after ThAAA repair with no evidence of neuro-TFPI may limit ischemia-reperfusion (IR) injury. Our logic insult, yet subsequently develop paraplegia over experiment was designed to evaluate the effects of the next few days.

We have previously reported our expedence wtlh ultraso~d anglopfaaty in experimental and dinicat settings. These sit.as sug~e~ that ulVasound selectively ablates thrombi with a wide margin of safety. The purpose of this study is to evaluate, for Ille first time, the clinical fees~lity of percutaneous comnan] ultrasound thromb~lysis (ULTH) as the primary repeduslon therapy in acute myocardial infarction (MI). The uHresouP, d thmmbolysis device consists of a solid metal probe with a distal multi-wire flexible segment, cor~ nected to a 1,6 mm tip. The device fits into a 1 OF guiding calheter over 0,014" guidewtm. Eligible patients had acute anterior MI and TIMI 0-1 flow in the LAD, To date, ULTH was attempted in 6 consecutive patients (10ts). In first pt. ULTH failed. In the follOwing consecutive 5 pts, following a change in the technique, sonfcatton (45 kHz, 18 Watts. 3 m) induced TIMI grade 3 flow, MLD of 1.7 :J: 0.9 mm and residual stenosis of 45 ~ 24%. There were no dissections, perforations, embolizations or spasm. There were no adverse events during ULTH. Adjunct PTCA, employed in all pts, resulted in final MLD of 2.3 :J: 0.3 mm and residual atenosis of 12 :~ Ib'%. Repeat ang~ at 10 rain and 24 hr revealed TIMI 3 flow in all pis. In.hospital, 1 Pt. developed acute closure on day 5 that was lmated successfully by PTCA. There were no deaths, bleeding or need for vascular repair. Conclusion: ULTH is potentially a safe and effective device solution for reperfusion therapy in the setting of ML ~ lntracoronary Adenosine as an Adjunct to