Intracoronary thrombolysis in patients with ST-segment elevation myocardial infarction presenting with massive intraluminal thrombus and failed aspiration

Boscarelli, Daniela; Vaquerizo, Beatriz; Miranda-Guardiola, Faustin; Arzamendi, Dabit; Tizón, Helena; Sierra, Gilberto; Delgado, Guillermo; Fantuzzi, Andres; Estrada, Darlene; García-Picart, Joan; Cinca, Juan; Serra, Antonio

doi:10.1177/2048872614527008

Cited by 37 publications

(28 citation statements)

References 23 publications

(34 reference statements)

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“…In our study, significant improvements in epicardial (cTFC) and myocardial (MBG) coronaryflow were found with the use of low dose intracoronary alteplase. Using different intracoronary thrombolytics, Sezer, et al [12] (using streptokinase) Boscarelli, et al, [13] (using alteplase and tenectplase) and Jayagopal and Sarjun-Basha, [14] (using tenectplase) found the same results. More physiologically, Sezer, et al [12] found that coronary flow reserve, index of microvascular resistance and Pressure derived collateral flow index were significantly lower in alteplase group.…”

Section: Acute Effects Of Intracoronary Alteplase Infusionmentioning

confidence: 81%

“…Export® catheter was used for manual thrombectomy as well as alteplase infusion for patients in alteplase group. The dose used was 0.3 mg/ kg as previously [13] which was infused just proximal to stent level over 5 minutes. The last angiogram was taken 15 minutes after completing the infusion.…”

Section: Primary Pcimentioning

confidence: 99%

“…The use of intra-coronary thrombolysis (e.g. Alteplase) immediately after PPCI was tested and showed improved epicardial and microvascular coronary flow [12][13][14].…”

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confidence: 99%

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Impact of Low-Dose Intracoronary Alteplase Infusion after Successful Primary Percutaneous Coronary Intervention

Ibrahim¹,

Eldamanhory²,

Abdelaziz³

et al. 2019

Int J Clin Cardiol

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Background and aim: In ST elevation myocardial infarction (STEMI), intracoronary thrombolysis after primary percutaneous coronary intervention (PPCI) was found to improve microvascular perfusion, yet without improvement in left ventricular (LV) remodeling. Our study aimed to find out possible effect on LV longitudinal function. Methods and results: 102 anterior STEMI patients eligible for PPCI were divided into: Alteplase group (53 patients; received intracoronary 0.3 mg/kg alteplase after PPCI) and control group (49 patients; treated with PPCI only). LV longitudinal function was assessed using tissue Doppler imaging (to measure mean S' and maximum Q-S' time difference) and speckle tracking (to measure global longitudinal strain (GLS)) 48 hours and 6 months after PPCI. In alteplase group, epicardial (p value < 0.001 for corrected TIMI frame count) and myocardial perfusion (p value for myocardial blush grade 0.03) were significantly higher. GLS and LV synchrony were better in alteplase group both at 48 hours (p value 0.02 and < 0.001 respectively) and at 6 months (p value < 0.001 for each). No difference in bleeding rates was noted between groups. Conclusion: Adjunctive low-dose alteplase infusion after PPCI improves microvascular perfusion and LV longitudinal function without increasing bleeding risk. ReseARch ARtIcle Inclusion criteria-First anterior wall STEMI suitable for PPCI of the infarct related artery (IRA).

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Section: Acute Effects Of Intracoronary Alteplase Infusionmentioning

confidence: 81%

Section: Primary Pcimentioning

confidence: 99%

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Impact of Low-Dose Intracoronary Alteplase Infusion after Successful Primary Percutaneous Coronary Intervention

Ibrahim¹,

Eldamanhory²,

Abdelaziz³

et al. 2019

Int J Clin Cardiol

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“…Kelly et al [12] reported that intracoronary infusion of tenecteplase was safe and effective for coronary flow recovery in patients with myocardial infarction. More recently, Boscarelli et al [13] found that adjuvant intracoronary infusion of low dose tenecteplase and alteplase in STEMI significantly reduced the thrombi remaining after MAT and improved coronary blood flow. Several case reports of massive intracoronary thrombosis also described successful recovery of coronary blood flow after intracoronary thrombolysis using alteplase [14] and tenecteplase [15].…”

Section: Discussionmentioning

confidence: 99%

A case of successful reperfusion through a combination of intracoronary thrombolysis and aspiration thrombectomy in ST-segment elevation myocardial infarction associated with an ectatic coronary artery

Lee

Kim

et al. 2017

BMC Cardiovasc Disord

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BackgroundLarge thrombus burdens in ectatic coronary arteries that remain after aspiration thrombectomy can negatively impact outcomes following percutaneous coronary interventions in patients with acute myocardial infarction.Case presentationA 53-year-old man presented with ST-segment elevation myocardial infarction (STEMI). Coronary angiography revealed an ectatic right coronary artery (RCA) that was completely occluded in the mid portion by a large amount of thrombus. Catheter-directed intracoronary thrombolysis with alteplase led to recovery of coronary blood flow, which multiple attempts of aspiration thrombectomy had failed to achieve. Coronary angiography 9 days later showed good blood flow and insignificant stenosis remaining in the RCA; this had completely resolved in 6 months’ follow-up coronary angiography.ConclusionCatheter-directed intracoronary thrombolysis can be performed effectively and safely when repeat aspiration thrombectomy fails to produce satisfactory coronary reperfusion in STEMI patients with large thrombus burdens in ectatic coronary arteries.

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“…19 Similarly, intracoronary fibrinolysis with low-dose urokinase, tenecteplase or alteplase has also been described in cases of large thrombus burden and failed manual aspiration. 20,21 It is surprising that in the study by Luz et al, 12 while aspirin 300 mg and clopidogrel 600 mg were given to all patients before PCI, use of Gp IIb/IIIa inhibitors was low overall and similar in those with ineffective (38%) and effective TA (33.5%). In the Portuguese National Registry of Interventional Cardiology, of 3311 patients who underwent thrombectomy between January 2006 and December 2012 (performed in 46.1% of PCI procedures in 2012), use of Gp IIb/IIIa inhibitors was also low (36.9%) but significantly higher than in those undergoing primary angioplasty alone (18.9%, p=0.001).…”

mentioning

confidence: 99%

Aspiration thrombectomy: Just another piece of the puzzle – Intuitive, but not sufficient

Gomes

2014

Revista Portuguesa de Cardiologia (English Edition)

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Aspiration thrombectomy: Just another piece of the puzzle ---Intuitive, but not sufficient ଝ Trombectomia aspirativa: apenas mais uma peça do puzzle. Intuitiva, mas não suficiente Thrombotic occlusion of a coronary artery was identified over 30 years ago as the pathophysiological mechanism of myocardial infarction (MI). In 1979, Rentrop et al. 1 first reported successful reperfusion by recanalizing an occluded coronary artery with a guidewire and directly infusing streptokinase. The following year, DeWood et al. 2 demonstrated spontaneous regression of occlusive thrombi in some patients undergoing coronary angiography within 24 hours of symptom onset of MI.Preventing the formation of thrombi in chronic coronary disease, or dissolving them and proceeding to early recanalization in the acute phase of MI, then became the main therapeutic goal in reducing mortality. DOI of original article: http://dx.

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Intracoronary thrombolysis in patients with ST-segment elevation myocardial infarction presenting with massive intraluminal thrombus and failed aspiration

Abstract: In STEMI patients with a large thrombus burden and failed manual aspiration, administration of low dose intracoronary thrombolysis is safe and reduces trhombus burden, as a result improving in epicardial flow and myocardial reperfusion.

Cited by 37 publications

References 23 publications

Impact of Low-Dose Intracoronary Alteplase Infusion after Successful Primary Percutaneous Coronary Intervention

Impact of Low-Dose Intracoronary Alteplase Infusion after Successful Primary Percutaneous Coronary Intervention

A case of successful reperfusion through a combination of intracoronary thrombolysis and aspiration thrombectomy in ST-segment elevation myocardial infarction associated with an ectatic coronary artery

Aspiration thrombectomy: Just another piece of the puzzle – Intuitive, but not sufficient

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