Intracoronary tenecteplase in STEMI with massive thrombus

Abstract

Primary percutaneous coronary intervention is the current standard of care in ST elevation myocardial infarction (STEMI). However, large thrombus is an independent predictor for stent thrombosis and major adverse cardiac events in patients undergoing primary angioplasty for STEMI. Here we report a series of STEMI patients with large thrombus burden treated successfully with low dose intracoronary thrombolysis. There was prompt and early ST resolution. There was improvement in thrombolysis in myocardial infarction (TIMI) flow and myocardial blush grade postlysis in all patients. Majority had recanalised infarct related coronary artery thus obviating the need for stenting. There was no inhospital or 1 month mortality or bleeding events. Hence intracoronary thrombolysis is an option in patients with large thrombus burden.

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

“…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.…”

“…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].…”

Use of Intracoronary Thrombolysis for Huge Thrombus Burden in an Ectatic Right Coronary Artery

“…11 Jayagopal Basha recently published a series of nine cases where IC tenecteplase was used successfully in patients with very high thrombus burden. 14 In the series, TNK was given IC at one fifth the systemic dose and the remaining four fifths were given systemically along with intravenous unfractionated heparin. All the patients had prompt and complete ST resolution and improvement in their TIMI myocardial blush grade with no patients having any significant bleeding.…”