summARY The angiographic appearance of the coronary arteries during successful thrombolysis with urokinase was determined in 35 patients with acute myocardial infarction. The lysing process passed through several phases: (a) total coronary occlusion with a convex or irregular distal margin (phase 0); (b) increasing patency of the lumen (phase 1); (c) re-establishment of flow but with intraluninal filling defects and delayed distal flow possibly due to microemboli (phase 2); (d) partial or complete disappearance of the filling defects (phase 3); and (e) further widening of the lumen which eventually attains a smooth regular outline (phase 4). The angiographic features which indicate the presence of coronary thrombosis are occlusion with an irregular or scalloped margin, stining with contrast medium, and progressive patency of the occluded vessel showing intraluminal filling defects.Coronary thrombosis occurring during the first hours after acute myocardial infarction has recently been reported with increased frequency,13 and its relation with transmural necrosis has been established. Thrombolytic treatment has been successfully used to achieve reperfusion of occluded coronary arteries.4-6 Although coronary angiography has become crucial in detecting thrombi, the criteria for the angiographic diagnosis of coronary thrombi are not well defined. To clarify this problem we reviewed the serial angiograms of patients with acute myocardial infarction who were treated with intracoronary urokinase infusion. Using these data we have described the coronary artery anatomy during selective thrombolysis and outlined a system of classifying the angiographic features.
Patients and methods
PATIENT SELECTIONWe reviewed the clinical records of 48 patients with acute myocardial infarction treated with intracoronary infusion of urokinase who had undergone coronary angiography within six hours of the onset of symptoms. During this time all patients received only routine support and pain relief. None was taking anti-
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