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Lesion-directed administration of alteplase with intracoronary heparin in patients with unstable angina and coronary thrombus undergoing angioplasty
Authors
Frank V. Aguirre
Eric R. Bates
+14 more
Glenn J. Beauman
Lisa G. Berdan
Edwin G. Bovill
Robert H. Christenson
Charles J. Davidson
Paul A. Gurbel
James B. Hermillerxyj
Jeffrey D. Leimberger
Michael J. Miller
Brent Muhlstein
David W. M. Muller
Frank I. Navetta
E. Magnus Ohman
Alan N. Tenaglia
Publication date
1 April 1996
Publisher
'Wiley'
Doi
Abstract
Percutaneous coronary revascularization in patients with unstable angina and coronary thrombus carries a high complication rate. A new strategy to reduce thrombus burden before revascularization was tested in a multicenter prospective trial. Patients with unstable angina and coronary thrombus (n = 45) received alteplase through an infusion catheter at the proximal aspect of the target lesion and concomitant intracoronary heparin via a standard guiding catheter. Angiography was performed before and after lesiondirected therapy and post-intervention. Systemic fibrinogen depletion and thrombin activation were not observed, while fibrinolysis was evident for ≥4 hr after treatment. Target lesion stenosis did not change significantly after lesion-directed therapy, but thrombus score was reduced, particularly among patients who had large thrombi (mean 2.2 vs. 1.6, P = 0.02). Revascularization was successful in 89% of patients. Median final stenosis was 30% and mean final thrombus score was 0.4. Complications included recurrent ischemia (11%), MI (7%), abrupt closure (7%), severe bleeding (4%), and repeat emergency angioplasty (2%). Patients with overt thrombus appeared to derive the most angiograpnic benefit from lesion-directed alteplase plus intracoronary heparin. Later revascularization was highly successful. This strategy may be a useful adjunct to percutaneous revascularization for patients with unstable angina and frank intracoronary thrombus. © 1996 Wiley-Liss, Inc.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/38222/1/1810370409_ftp.pd
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Last time updated on 25/05/2012