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 language | English (US) |
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Pages (from-to) | 382-391 |
Number of pages | 10 |
Journal | Catheterization and cardiovascular diagnosis |
Volume | 37 |
Issue number | 4 |
DOIs | |
State | Published - Apr 1996 |
Keywords
- PTCA
- anticoagulation
- thrombolysis
- thrombus
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine