Reduced-Dose Alteplase for Residual Thrombus

If residual thrombus (defined as thrombus removal grade ≤ I) was present and did not meet the exclusion criterion of thrombolytic contraindications, a continuous infusion of reduced-dose recombinant tissue plasminogen activator (rt-PA) (Alteplase; Boehringer-Ingelheim, Ingelheim am Rhein, Germany) was delivered subsequently via a multi-side hole catheter (Uni*Fuse, AngioDynamics, Boston Scientific, USA) embedding into the thrombus. Then, 17 mg/20 mg Alteplase was administered at an infusion rate of 0.01 mg/kg per hour following CDT. The maximum rate was less than 1.0 mg/h, and the total doses were less than 50 mg, as noted elsewhere [8 (link)]. CDT was discontinued when at least 80% clot lysis with restoration of flow or a serious complication occurred. Alteplase was administered only when the fibrinogen level was > 1.0 g/L.