Percutaneous transluminal coronary angioplasty immediately after intracoronary streptolysis of transmural myocardial infarction.

Abstract

SUMMARY Percutaneous transluminal coronary angioplasty (PTCA) was performed in 21 patients with acute myocardial infarction (AMI) treated by intracoronary infusion of streptokinase within 8 hours after the onset of symptoms. Streptolysis therapy began a mean of 3.6 1.2 hours (±+ SD) after the onset of symptoms. The vessel was occluded in 14 patients and highly stenosed in seven. After the infusion of 67,300 + 63,200 IU of streptokinase over 26.1 21.5 minutes, patency of the occluded vessels was reached.PTCA as performed 20-60 minutes after the end of streptokinase treatment in 19 patients and 24 and 31 hours after treatment in two patients. The dilation was successful in 17 patients (81%). The degree of vessel obstruction was reduced from 90.2 + 7.3% to 58.6 19.5% (area method) and from 71.4 + 12.4% to 39.2 + 19.7% (diameter method). The improvement was 31.5 18.4% and 32.2 ± 19.3%, respectively. No reocclusion was induced by PTCA. Twenty patients were discharged. One died during hospitalization; at autopsy, the treated vessel was still patent. During the follow-up period, two reinfarctions and one asymptomatic reocclusion occurred.The clinical findings during the hospital course and the follow-up period were compared with those of a control group of 18 patients with AMI and comparable coronary stenoses who were treated only with streptokinase infusion. Four of these patients had a reinfarction during the hospital course, and three died during the follow-up period.PTCA can be performed safely and successfully immediately after intracoronary infusion of streptokinase in patients with AMI. By reducing the subtotal stenosis, this treatment contributes to the reperfusion of the ischemic myocardium, diminishes the risk of a reocclusion and seems to improve the prognosis.

Rethrombosis after reperfusion with streptokinase: importance of geometry of residual lesions.

“…2 In contrast to this line of reasoning, several anatomic studies3-' have shown that a substantial percentage of lesions associated with vessel thrombosis and acute myocardial infarction are moderate in severity. The complexity of this issue is further compounded by the fact that there are at least three reasons why the appearance of lesions immediately after streptokinase reper-clude the following: (1) unlysed thrombi may be associated with the stenosis, (2) there may be coronary spasm at the site of the stenosis that is resistant to traditional vasodilatory therapy, and (3) there may be acute plaque rupture that may "remodel" over a period of days or weeks.…”

The Coronary Angiogram and Its Seminal Contributions to Cardiovascular Medicine Over Five Decades

“…This operation was first carried out in 1982 by Meyer and colleagues in Germany. 30 From then until now a heated debate has existed over which of the 2 methods of reperfusion provides the greatest benefit for the management of a patient with an acute myocardial infarction. 31 More than 2 dozen randomized, controlled trials have been undertaken since the initial study reported 15 years ago by O'Neil and colleagues 32 in an attempt to resolve this dispute.…”

Intravenous versus intracoronary streptokinase in acute myocardial infarction

“…Studies have also been done employing percutaneous transluminal angioplasty after thrombolysis (Gold et al, 1984;Meyer et al, 1982;Papapiotro et al, 1985). An advantage of ICSK is that angioplasty, if indicated, can potentially be performed immediately after thrombolysis.…”