Pulse-spray pharmacomechanical thrombolysis.

The synergistic potential of combining pharmacologic and mechanical methods of thrombolysis has recently been recognized. Pulse-spray pharmacomechanical thrombolysis is one such method, which in our experience has markedly increased the efficiency and acceptability of thrombolysis. With this technique, dialysis grafts usually require only 20-35 min for thrombolysis; bypass grafts or native arteries usually require 60-150 min. The entire procedure is accomplished in one session within the angiography suite, including the supplemental transluminal angioplasty, atherectomy, or stenting that is usually also necessary. Clear understanding of the principle of the method and meticulous attention to technical details is essential for maximal speed, safety, and efficacy.