Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions · 2026
Systemic Thrombolytic Resistance in Antithrombin III Deficiency Rescued by Catheter-Directed Thrombolysis: A Case Report.
Клинический случайСтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Son Byeng-Ju, Jung Sungyun, Kim Byung-Jun, Kim Hong-Ju, Jeong Jun-Chang, Kim Hyongjun
Аннотация
BACKGROUND: Hereditary antithrombin III (AT III) deficiency is a rare thrombophilic disorder that may cause resistance to systemic thrombolytic therapy. We report a case of massive iliofemoral deep-vein thrombosis (DVT) with high-risk pulmonary thromboembolism (PTE) refractory to systemic thrombolysis, successfully treated with catheter-directed thrombolysis (CDT).
CASE SUMMARY: A previously healthy 33-year-old man presented with dyspnoea and left-leg swelling. Imaging revealed bilateral pulmonary-artery thrombi with acute right-ventricular failure and extensive iliofemoral DVT. Despite systemic alteplase infusion, thrombus resolution was incomplete, and hereditary AT III deficiency (53% activity) was diagnosed. CDT via the right femoral vein was performed using alteplase (0.02 mg/kg/h for 48 h), achieving near-complete thrombus resolution and restoration of venous flow without bleeding complications.
DISCUSSION: This case highlights systemic thrombolysis failure associated with AT III deficiency and demonstrates that CDT can serve as an effective, low-bleeding-risk rescue therapy for extensive DVT when systemic treatment is inadequate. These findings underscore the importance of early recognition of AT III deficiency and consideration of catheter-based intervention in similar high-risk settings.
CASE SUMMARY: A previously healthy 33-year-old man presented with dyspnoea and left-leg swelling. Imaging revealed bilateral pulmonary-artery thrombi with acute right-ventricular failure and extensive iliofemoral DVT. Despite systemic alteplase infusion, thrombus resolution was incomplete, and hereditary AT III deficiency (53% activity) was diagnosed. CDT via the right femoral vein was performed using alteplase (0.02 mg/kg/h for 48 h), achieving near-complete thrombus resolution and restoration of venous flow without bleeding complications.
DISCUSSION: This case highlights systemic thrombolysis failure associated with AT III deficiency and demonstrates that CDT can serve as an effective, low-bleeding-risk rescue therapy for extensive DVT when systemic treatment is inadequate. These findings underscore the importance of early recognition of AT III deficiency and consideration of catheter-based intervention in similar high-risk settings.