Lesion-directed administration of alteplase with intracoronary heparin in patients with unstable angina and coronary thrombus undergoing angioplasty

Paul A. Gurbel, Frank I. Navetta, Eric R. Bates, David W. Muller, Alan N. Tenaglia, Michael J. Miller, Brent Muhlstein, James B. Hermiller, Charles J. Davidson, Frank V. Aguirre, Glenn J. Beauman, Lisa G. Berdan, Jeffrey D. Leimberger, Edwin G. Bovill, Robert H. Christenson, E. Magnus Ohman*

*Corresponding author for this work

Research output: Contribution to journalArticle

17 Scopus citations

Abstract

Percutaneous coronary revascularization in patients with unstable angina and coronary thrombus carries a high complication rate. A new strategy to reduce thrombus burden before revascularization was tested in a multicenter prospective trial. Patients with unstable angina and coronary thrombus (n = 45) received alteplase through an infusion catheter st the proximal aspect of the target lesion and concomitant intracoronary heparin via a standard guiding catheter. Angiography was performed before and after lesion-directed therapy and post-intervention. Systemic fibrinogen depletion and thrombin activation were not observed, while fibrinolysis was evident for ≥4 hr after treatment. Target lesion stenosis did not change significantly after lesion- directed therapy, but thrombus score was reduced, particularly among patients who had large thrombi (mean 2.2 vs. 1.6, P = 0.02). Revascularization was successful in 89% of patients. Median final stenosis was 30% and mean final thrombus score was 0.4. Complications included recurrent ischemia (11%), MI (7%), abrupt closure (7%), severe bleeding (4%), and repeat emergency angioplasty (2%). Patients with overt thrombus appeared to derive the most angiographic benefit from lesion-directed alteplase plus intracoronary heparin. Later revascularization was highly successful. This strategy may be a useful adjunct to percutaneous revascularization for patients with unstable angina and frank intracoronary thrombus.

Original languageEnglish (US)
Pages (from-to)382-391
Number of pages10
JournalCatheterization and cardiovascular diagnosis
Volume37
Issue number4
DOIs
StatePublished - Apr 1996

Keywords

  • PTCA
  • anticoagulation
  • thrombolysis
  • thrombus

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Gurbel, P. A., Navetta, F. I., Bates, E. R., Muller, D. W., Tenaglia, A. N., Miller, M. J., Muhlstein, B., Hermiller, J. B., Davidson, C. J., Aguirre, F. V., Beauman, G. J., Berdan, L. G., Leimberger, J. D., Bovill, E. G., Christenson, R. H., & Ohman, E. M. (1996). Lesion-directed administration of alteplase with intracoronary heparin in patients with unstable angina and coronary thrombus undergoing angioplasty. Catheterization and cardiovascular diagnosis, 37(4), 382-391. https://doi.org/10.1002/(SICI)1097-0304(199604)37:4<382::AID-CCD8>3.0.CO;2-7