{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T06:08:19Z","timestamp":1778825299965,"version":"3.51.4"},"reference-count":13,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2026,3,24]],"date-time":"2026-03-24T00:00:00Z","timestamp":1774310400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,3,24]],"date-time":"2026-03-24T00:00:00Z","timestamp":1774310400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cathet Cardio Intervent"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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\u2010vein thrombosis (DVT) with high\u2010risk pulmonary thromboembolism (PTE) refractory to systemic thrombolysis, successfully treated with catheter\u2010directed thrombolysis (CDT).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case Summary<\/jats:title>\n                    <jats:p>A previously healthy 33\u2010year\u2010old man presented with dyspnoea and left\u2010leg swelling. Imaging revealed bilateral pulmonary\u2010artery thrombi with acute right\u2010ventricular 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\u2009mg\/kg\/h for 48\u2009h), achieving near\u2010complete thrombus resolution and restoration of venous flow without bleeding complications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>This case highlights systemic thrombolysis failure associated with AT III deficiency and demonstrates that CDT can serve as an effective, low\u2010bleeding\u2010risk 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\u2010based intervention in similar high\u2010risk settings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ccd.70569","type":"journal-article","created":{"date-parts":[[2026,3,25]],"date-time":"2026-03-25T03:34:13Z","timestamp":1774409653000},"page":"2032-2035","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Systemic Thrombolytic Resistance in Antithrombin III Deficiency Rescued by Catheter\u2010Directed Thrombolysis: A Case Report"],"prefix":"10.1002","volume":"107","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1442-8465","authenticated-orcid":false,"given":"Byeng\u2010Ju","family":"Son","sequence":"first","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine Dongkang Medical Center Ulsan Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sungyun","family":"Jung","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine Dongkang Medical Center Ulsan Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7251-4690","authenticated-orcid":false,"given":"Byung\u2010Jun","family":"Kim","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine Dongkang Medical Center Ulsan Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3510-3774","authenticated-orcid":false,"given":"Hong\u2010Ju","family":"Kim","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine Dongkang Medical Center Ulsan Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-6778-6151","authenticated-orcid":false,"given":"Jun\u2010Chang","family":"Jeong","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine Yeungnam University Medical Center Daegu Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hyongjun","family":"Kim","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine Dongkang Medical Center Ulsan Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2026,3,24]]},"reference":[{"key":"e_1_2_8_2_1","first-page":"761","article-title":"Mild Antithrombin Deficiency and Risk of Recurrent Venous Thromboembolism","volume":"129","author":"Stehl\u00edkov\u00e1 O.","year":"2014","journal-title":"Circulation"},{"key":"e_1_2_8_3_1","first-page":"2450","article-title":"Thrombotic Risk in Hereditary Antithrombin Deficiency: A Multicentre Italian Cohort","volume":"105","author":"Pengo V.","year":"2020","journal-title":"Haematologica"},{"key":"e_1_2_8_4_1","first-page":"1634","article-title":"Clinical Guidelines for Testing for Heritable Thrombophilia","volume":"115","author":"Baglin T.","year":"2010","journal-title":"Blood"},{"key":"e_1_2_8_5_1","first-page":"549","article-title":"Catheter\u2010Directed Thrombolysis (Intrathrombus Injection) in Treatment of Deep Venous Thrombosis: A Systematic Review","volume":"71","author":"Alesh I.","year":"2007","journal-title":"Catheterization and Cardiovascular Interventions"},{"key":"e_1_2_8_6_1","first-page":"298","article-title":"Successful Catheter\u2010Directed Thrombolysis After Failed Systemic Therapy in Massive Pulmonary Embolism","volume":"96","author":"Choi B. G.","year":"2020","journal-title":"Catheterization and Cardiovascular Interventions"},{"key":"e_1_2_8_7_1","first-page":"1153","article-title":"Catheter\u2010Directed Thrombolysis for Acute Iliofemoral Deep Venous Thrombosis: Safety and Efficacy","volume":"41","author":"Ogawa T.","year":"2018","journal-title":"Cardiovascular and Interventional Radiology"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1615066"},{"key":"e_1_2_8_9_1","first-page":"255","article-title":"Catheter\u2010Directed Thrombolysis in Iliofemoral Deep Venous Thrombosis: A Review","volume":"18","author":"Baekgaard N.","year":"2020","journal-title":"Journal of thrombosis and haemostasis: JTH"},{"key":"e_1_2_8_10_1","first-page":"5","article-title":"Mid\u2010Term Results of Catheter\u2010Directed Thrombolysis for Iliofemoral Deep Vein Thrombosis","volume":"4","author":"Kwon T. W.","year":"2021","journal-title":"CVIR Endovasc"},{"issue":"2","key":"e_1_2_8_11_1","article-title":"Management of Venous Thromboembolism Associated With Antithrombin III Deficiency and May\u2010Thurner Syndrome: A Case Report","volume":"5","author":"Seung\u2010Bin Y.","year":"2021","journal-title":"Eur Heart J Case Rep"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1615066"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCOUTCOMES.119.005659"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejvs.2020.09.023"}],"container-title":["Catheterization and Cardiovascular Interventions"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ccd.70569","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/ccd.70569","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ccd.70569","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T05:18:49Z","timestamp":1778822329000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/ccd.70569"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,24]]},"references-count":13,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2026,5]]}},"alternative-id":["10.1002\/ccd.70569"],"URL":"https:\/\/doi.org\/10.1002\/ccd.70569","archive":["Portico"],"relation":{},"ISSN":["1522-1946","1522-726X"],"issn-type":[{"value":"1522-1946","type":"print"},{"value":"1522-726X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,24]]},"assertion":[{"value":"2025-10-30","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-03-16","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-03-24","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}