Safety and efficacy of intracoronary thrombolytic therapy via a new infusion catheter in patients with ST-segment elevation myocardial infarction with large thrombus burden: a pilot study.

Abstract

BACKGROUND:

A large intracoronary thrombus burden is associated with adverse clinical results. The optimal management of this scenario remains unknown. We aimed to determine the efficacy and safety of a new rapid infusion catheter combined with low-dose intracoronary thrombolysis in patients with ST-segment elevation myocardial infarction (STEMI) with a large thrombus burden.

METHODS AND RESULTS:

This pilot study included 22 patients with STEMI with a large thrombus burden. A large thrombus burden was defined as a definite thrombus with the largest dimension of at least two vessel diameters [thrombolysis in myocardial infarction (TIMI) thrombus grades 4 and 5]. All patients received primary percutaneous coronary intervention guided by the presence of recurrent chest pain or clinical myocardial ischemia evidences. All patients regained myocardial perfusion immediately after the infusion catheter crossed the thrombus. Local fibrinolysis with low-dose recombinant human prourokinase was administered continuously via the infusion catheter for 30 min. Repeat coronary angiography revealed marked thrombus resolution, with an improvement in TIMI flow from 0.14 ± 0.35 at baseline to 2.82 ± 0.40. Only one patient with postlysis thrombus grades 4-5 was observed. No major bleeding events were observed.

CONCLUSIONS:

In patients with STEMI presenting with a large thrombus burden, all patients regained myocardial perfusion immediately after the infusion catheter crossed over the thrombus, and low doses of intracoronary thrombolysis could significantly reduce the thrombus burden and improve the coronary flow without major bleeding.

• Authors: Tao Chen, Qi Wang, Ge Liu, Qinhua Jin, Changfu Liu, Lei Gao, Yundai Chen, Jun Guo
• Journal: Coronary artery disease (Coron Artery Dis) Vol. 32 Issue 3 Pg. 205-210 (May 01 2021) ISSN: 1473-5830 [Electronic] England
• PMID: 32558694 (Publication Type: Journal Article)
• Copyright: Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

Chemical References

• Fibrinolytic Agents

Topics

• Aged
• Cardiac Catheterization (instrumentation)
• China
• Coronary Thrombosis (drug therapy)
• Equipment Design
• Female
• Fibrinolytic Agents (therapeutic use)
• Humans
• Male
• Middle Aged
• Pilot Projects
• ST Elevation Myocardial Infarction (drug therapy)
• Thrombolytic Therapy (instrumentation)