Successful Revascularization of Coronary Artery Occluded by Massive Intracoronary Thrombi with Alteplase and Percutaneous Coronary Intervention

Abstract

A 67-year-old man was admitted to our institution with sudden and pessistant chest pain for 3 days. Coronary angiography showed massive thrombotic occlusion of the right coronary artery. The patient received intracoronary thrombolysis with alteplase (recombinant tissue-type plasminogen activator, rt-PA). On repeated angiography, there was marked resolution of intracoronary thrombus. After percutaneous coronary intervention with stent implantation, the final result was complete revascularization of the right coronary artery (TIMI grade 3 distal flow). This case demonstrates that intracoronary rt-PA can result in local thrombus reduction in patients undergoing PCI, especially with a large thrombus burden.

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

“…One-third of the systemic dose was used based on the limited previously reported data and depending on patient’s weight. 7,9,10 After lytic bolus injection was given, repeated manual aspiration was recommended and after 10–15 min, an angiographic final control was performed.…”

“…3,6 In this regard, intracoronary thrombolysis has demonstrated promising results in ST-elevation myocardial infarction (STEMI) patients during primary percutaneous coronary intervention (PCI) 7,8 as well as an adjunct to PCI in cases of a large thrombus burden. 9,10 We report our experience with the use of low dose of intracoronary thrombolytic agents administered through a 6F-dual lumen catheter for massive intracoronary thrombosis in STEMI when routine thrombectomy has been ineffective.…”

Successful Intracoronary Thrombolysis in Acute ST Elevation Myocardial Infarction Patient With Uncorrected Tetralogy of Fallot

“…Recommended procedure for those patients during PCI was firstly catheter thrombus aspiration to reduce thrombus burden before next decisions. In cases of failure with thrombus aspiration, defined as TTG ≥ 2, distal embolization or slow-flow, intracoronary thrombolysis could be a good additional therapy [10][11][12][13]. Thrombolytic agents and their doses were different among reports, which could be streptokinase, alteplase, tenecteplase, etc., at full or reduced dose in comparison with systemic venous thrombolysis.…”

Successful intracoronary thrombolysis in a patient with anterior myocardial infarction and large thrombus burden associated with coronary artery ectasia

“…They injected 5 units of Reteplase into the LM artery within 2 minutes, which leads to rapid blood flow to the LCX artery but due to the complexity of the lesion, the patient underwent angioplasty with stent. In other studies, generally, Streptokinase, Alteplase, 1,6 and Tenecteplase 7 were used to resolve large IC thrombus, but we used Reteplase for this purpose due to mere access to this agent. We used half of the standard Intravenous dose of Reteplase for IC thrombolysis.…”