KOMPLKASYONLAR &

LGN OLGULAR

Prof. Dr. Ender SEMZ Medical Park Gebze Hastanesi

49 yanda, erkek hasta Darda gezerken senkop ata, kafa

travmas Gtrld hastanede EKG deiiklii ve

TR: 0.14 >>> Q dalgasz MI tansyla sevk Acil servise getirildiinde genel durumu iyi,

obez, kan basnc 16-10 cmHg, kalp-akcier muayenesi normal

zgemiinde NIDDM, hipertansiyon Senkop ve kafa travmas nedeni ile acil

serviste BBT ekimi

18.02.2012

Koroner youn bakma yatrlan hastada ilk laboratuvar deerleri:

Hg: 14.4gm, lkosit: 12.250, trombosit: 207000, Tr I: 0.19, CK-MB: 9.8, Kreatinin: 0.8 mg, ALT: 45, AST: 23

Youn bakmda bulant-kusma, bilin kayb tekrar, ventrikler takikardi, kardiyovaskler arrest

Baarl canlandrmay takiben acil koroner anjiyografi

20.02.2012

ASA 300 mg, Fraxiparin 2x0.6cc, Metoprolol 50 mg, Amiodaron infzyonu, O2 tedavisi

Hg: 13gm, lkosit: 9620, trombosit: 208000,

Tr I: 0.32, CK-MB: 13, kreatinin: 1.1, ALT: 40, AST: 20, Na: 139, K: 4.5

Epigastrik duyarllk nedeni ile genel cerrahi konsltasyonu >> akut gastrit

Bradikardi ve kusmann devam etmesi, tekrarlayan arrest nedeni ile >>> Nroloji konsltasyonu: Fizik muayene normal. Kafa travmas yks nedeniyle nroirrji blmnce de grlmesi.

Acil serviste ekilen BBT >> Normal. ncelikli olarak vazo-vagal senkop dnld. Kardiyak

neden yok ise, EEG de ekilmek zere Nroloji polikliniine kontrol

Takipte genel durumu iyi, yaknmas yok. EKG Holteri ve gerekirse EF uygulanmak zere 4 gn

sonra taburcu

Taburcu olduktan 6 gn sonra tekrarlayan senkop ataklar ile tekrar yatrld.

Genel durumu iyi. Kan basnc normal, hafif takikardik ve takipneik. Kalp muayenesinde ek ses ya da frm yok.

Hg: 12.4gm, lkosit: 6930, trombosit: 288000, kreatinin: 0.9, Na: 139, K: 4.3, arteriyel kanda pH: 7.496, pO2: 52 mmHg, pCo2: 25.2 mmHg, %sO2: 90.1 HCO3: 19.5mmol

28.02.2012

28.02.2012

28.02.2012

Pulmoner emboli tans ile hastaya sistemik 100 mg tPA tedavisi uyguland (29.02.2012)

Heparin 1000 /saat Bilateral alt ekstremite venz Doppler:

Sol popliteal vende total tromboz ile uyumlu akm kayb, apta art ve kompresyona yantszlk

01.03.2012

02.03.2012

Ekosonic 106cm 40 cm endovascular device EKOS Corporation

Ekosonic 106cm 40 cm endovascular device EKOS Corporation

05.03.2012

07.03.2012 Aegisy vena cava filtresi Lifetech Scientific (Shenzhen) Co.

21.03.2012

Pulmonary Embolism Annual incidence

United States: >600,000; Europe >1,000,000

Up to 200,000 deaths in the US annually More die of PE in the US than AIDS, motor vehicle accidents & breast

cancer combined

PE categories Massive (5% of PE patients): 58% 90-day mortality rate

Patients present in hemodynamic collapse with cardiogenic shock; high early mortality rate due in part to right ventricular failure

Sub-massive (40% of PE patients): 22% 90-day mortality rate Presenting with thrombosis usually in one or both of the left and right pulmonary arteries, hemodynamic compensation and maintenance of adequate systolic arterial blood pressure albeit with right heart strain consistent with imminent right heart failure

Minor (55% of PE patients): 15% 90-day mortality rate Presenting with small clots in the distal pulmonary vessels, pleuritic chest pain, mild tachycardia and possibly hemoptysis Goldhaber SZ, Visani L, De Rosa M, et al. for ICOPER. Acute pulmonary embolism; clinical outcomes in the International Cooperative Pulmonary Embolism Registry. Lancet 1999;353:1386-1389

High Risk

Intermediate Risk

The Challenge why Thrombus Is So Difficult To Dissolve

Plasminogen receptor sites are embedded into thrombus during formation

Speed of lysis depends on ability of lytic to access plasminogen receptor sites**

Tightly wound fibrin strands prevent lytic from penetrating the thrombus, limiting access to plasminogen receptor sites

** Francis, Charles W. et al. Ultrasound Accelerates Transport of Recombinant Tissue Plasminogen Activator into Clots. Ultrasound in Medicine and Biology 21.3 (1995): 419-424.

Mechanism of Action

Ultrasound energy causes fibrin strands to thin and loosen, exposing plasminogen receptor sites

Thrombus permeability and thrombolytic penetration are dramatically increased

Ultrasonic pressure waves force drug deep into the clot and keep it there

Drug acts faster, clearing clot sooner with reduced bleeding complications, &

Ultrasound accelerated thrombolysis

WITH ULTRASOUND ENERGY

WITHOUT ULTRASOUND

ENERGY

ULTRASONIC ENERGY & THROMBOLYTIC

(Science studied over 4 decades)

No hemolysis No valve or wall damage Very low risk of embolization

Ultrasound mechanism of action

Standard Infusion Catheter

Spread of Stained t-PA

Plasma Clot Plasma Clot

Spread of Stained t-PA

EkoSonic Endovascular Device

Thrombus exposed to ultrasound absorbed 48% more t-PA in one hour, 84% more t-PA in two hours and 89% more t-PA in 4 hours than thrombus not exposed to ultrasound pressure.7

7Francis, CW, et al. Ultrasound Accelerates Transport of Recombinant Tissue Plasminogen Activator into Clots. Ultrasound in Medicine and Biology 21.3 (1995): 419-424.

Submassive Pulmonary Emboli, An Unrecognized And Often Fatal

Condition: Incidence, Diagnosis And Treatment With Ultrasonic Thrombolysis

38th Annual VEITHsymposium, New York, NY November 17, 2011

Tod C. Engelhardt, MD

Chair, Cardiovascular and Thoracic Surgery Division, East Jefferson General Hospital, Metairie, LA, USA

East Jefferson General Hospital New Orleans

Presenter Disclosure Financial:

T. Engelhardt is a consultant for EKOS Corporation

Approved Uses: The device used in this presentation has received European approval (CE Mark) for

the treatment of pulmonary embolism (PE) The device discussed in this presentation has been cleared by the US FDA for

placement in the PA for use with solutions

Unapproved/Unlabeled Uses: This presentation includes information on uses of drug and device that have not

been approved or cleared by the US FDA for PE treatment

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