Coronary angioplasty: Back to the future

Puel and Sigwart, in 1986, deployed the first coronary stent to act as a scaffold preventing vessel closure reducing the incidence of angiographic restenosis. The first stents were bare metal stents. The first drug-eluting stents to be approved were coated with paclitaxel or sirolimus. Since these stents came with a lot of promise but also with risk of thrombosis, the next step was biodegradable stents. These stents are expected to degrade into nontoxic byproducts. They came with a lot of fanfare but are now being viewed with caution because of initial poor results. We do not know what the future holds

Streptokinase versus recombinant tissue-type plasminogen activator for thrombolysis of mechanical prosthetic heart valve thrombosis

Aims and Objectives: This study was designed to compare streptokinase (STK) versus recombinant tissue-type plasminogen activator (rt-PA) for thrombolysis in patients with prosthetic heart valve thrombosis (PHVT). Background: Optimal management of PHVT remains controversial. Thrombolytic therapy is a reasonable alternative to surgery. Numerous thrombolytic protocols with STK, urokinase, and rt-PA have been used over the past 40 years. So far there is a lack of consensus on the ideal thrombolytic agent for PHVT. There are no major studies comparing efficacy of STK versus rt-PA. Methods and Results: Sixty patients who underwent thrombolysis for PHVT over 1 year were studied. Forty-eight patients were thrombolysed with STK, whereas 12 patients received rt-PA. Overall 68.33% (41/60) patients showed complete response (CR), whereas 85% (51/60) showed some improvement in hemodynamics, with no significant difference in efficacy according to age, sex, duration from surgery, New York Heart Association Class III–IV, presence of atrial fibrillation, type of valve, or history of stroke. Overall 10% patients developed major complications with mortality of 5%. CR to thrombolytic therapy was numerically better with STK (72.9% vs. 50%; P = 0.12) and mortality was significantly higher in rt-PA (16.6% vs. 2%, P = 0.038). Mean duration of successful thrombolysis was significantly longer with STK as compared to rt-PA (22.96 ± 19.2 vs. 3 h). Conclusion: STK use as compared to rt-PA was associated with numerically more successful thrombolysis and significant lower mortality, hence may be optimal for elective thrombolysis