Management of complicated coronary angioplasty by intracoronary urokinase and immediate re‐angioplasty

Abstract

Percutaneous transluminal coronary angioplasty was complicated by acute coronary occlusion, dissection of the arterial wall, or angiographic evidence of intraluminal thrombosis in 33 high-risk patients from 153 consecutive angioplasty procedures (21.5%). Ten patients (group I) were managed with nitroglycerin (0.2 to 0.4 mg i.c.) and repeated attempts at mechanical guide wire recanalization or dilation, but they did not receive thrombolytic therapy. In the remaining 23 patients (group II), intracoronary urokinase (100,000 to 360,000 U.I.) was administered over 15-20 min after onset of coronary occlusion or thrombosis and continued during attempts at repeated dilation of the stenosis. The incidence of sudden coronary artery occlusion was 70% in group I patients and 52% in group II. The angiographic evidence of thrombus formation was observed in a higher, but not significant, proportion of group II patients (65%) as compared with group I (30%). The incidence of intimal tearing or dissection was similar in the two groups of patients (40 vs. 34.7%). The overall final success rate of the complicated angioplasty series was 48% (6/33). However, the success rate was lower (10%) in group I than in group II patients (10 vs. 65%; P less than 0.005), and the frequency of emergency coronary artery bypass grafting was lower in group II patients (13 vs. 60%; P = 0.01), suggesting that thrombolytic therapy with urokinase may be effective in the management of acute coronary occlusion and thromboembolic complications of coronary angioplasty.

Adjunctive thrombolytic therapy during angioplasty for ischemic rest angina. Results of the TAUSA Trial. TAUSA Investigators. Thrombolysis and Angioplasty in Unstable Angina trial.

“…[5][6][7][8]19 Prolonged infusions of thrombolytic therapy have also been effective in dissolving large amounts of thrombus in saphenous vein grafts and native coronary arteries, permitting angioplasty to proceed without complication.2021…”

Combined Revascularization Strategy for Acute Myocardial Infarction in Patients With Intracoronary Thrombus

“…[12][13][14] The thrombus burden varies from case to case, and large thrombus is resistant to systemic thrombolysis and frequently triggers distal embolization or 'no reflow' after mechanical revascularization. [15][16][17] Intracoronary thrombolysis (ICT) is a method of treating thrombus with a higher concentration of thrombolytic agent and potentially could enhance flow restoration when combined with PTCA. In the present study, we investigated this treatment method by comparing primary PTCA without preceding thrombolysis in AMI patients with intracoronary thrombus, focusing on acute phase flow restoration.…”