Selective infusion of thrombolytic therapy in the acute myocardial infarct-related coronary artery as an alternative to rescue percutaneous transluminal coronary angioplasty

The management of patients with acute myocardial infarction in whom reperfusion has been unsuccessful with standard dose thrombolytic therapy remains controversial.¹ Rescue percutaneous transluminal coronary angioplasty (PTCA) has been associated with a high reocclusion rate after failed intravenous tissue plasminogen activator (TPA) with accompanying high morbidity and mortality.² It has been postulated that PTCA in the setting of thrombolytic therapy may induce subintimal hemorrhage, which may lead to reocclusion.³ As an alternative method for restoring coronary patency after failed intravenous TPA, we describe the results of selective intracoronary injection of a longer acting thrombolytic agent, without adjunctive PTCA, using an infusion catheter that provides a mechanical jet effect to disrupt the coronary thrombus. Use of this coronary thrombolytic technique was successful in each patient after failed intravenous TPA.