Efficacy of catheter-directed thrombolysis alone or combined with mechanical rotational thrombectomy for lower extremity arterial thrombotic occlusion: a retrospective cohort study

Limited literature is available regarding the use of catheter-directed thrombolysis (CDT) either alone or in combination with mechanical rotational thrombectomy (MRT) for the interventional treatment of acute or chronic lower extremity arterial thrombotic occlusion (LE-ATO). This study aimed to compare the one-year follow-up of CDT, both as a standalone treatment and in conjunction with MRT, in managing LE-ATO. The clinical data of 254 consecutive patients (259 limbs) with acute or chronic LE-ATO from January 2014 to January 2024 were retrospectively analysed. These patients were categorized into the CDT + MRT group and the CDT group. Perioperative data and the 1-year follow-up results were compared between the two groups. The primary outcome was the occurrence of major adverse limb event (MALE). The secondary outcomes were technical success, incidence of perioperative complications, and all-cause mortality. A total of 144 limbs presented with acute ischemia, and 115 limbs presented with chronic ischemia. The CDT + MRT group included 87 patients (90 limbs), and the CDT group included 167 patients (169 limbs). The technical success rates of the two groups were 87.8% and 75.7%, respectively. During the follow-up, 8 patients and 35 patients with MALE were significantly different between the two groups (Unadjusted hazard ratio [HR] = 2.445, 95%CI [1.134–5.273], p = 0.023; Adjusted HR = 2.201, 95%CI [1.018–4.758], p = 0.045. Perioperative bleeding and acute heart failure were observed more frequently in the CDT group. During the one-year follow-up period, a total of 28 (10.8%) patients with all-cause mortality were recorded across both groups. MRT may be a viable option for the treatment of both acute and chronic LE-ATO. In the interventional treatment of both acute and chronic LE-ATO, CDT + MRT might be associated with a lower incidence of MALE events, higher technical success rates and fewer perioperative complications than CDT alone.