Document Detail


Lesion-directed administration of alteplase with intracoronary heparin in patients with unstable angina and coronary thrombus undergoing angioplasty.
MedLine Citation:
PMID:  8721695     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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 alter lesion-directed therapy and post-intervention. Systemic fibrinogen depletion and thrombin activation were not observed, while fibrinolysis was evident for > or = 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 angiographic 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.
Authors:
P A Gurbel; F I Navetta; E R Bates; D W Muller; A N Tenaglia; M J Miller; B Muhlstein; J B Hermiller; C J Davidson; F V Aguirre; G J Beauman; L G Berdan; J D Leimberger; E G Bovill; R H Christenson; E M Ohman
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Publication Detail:
Type:  Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Catheterization and cardiovascular diagnosis     Volume:  37     ISSN:  0098-6569     ISO Abbreviation:  Cathet Cardiovasc Diagn     Publication Date:  1996 Apr 
Date Detail:
Created Date:  1996-09-17     Completed Date:  1996-09-17     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  7508512     Medline TA:  Cathet Cardiovasc Diagn     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  382-91     Citation Subset:  IM    
Affiliation:
Department of Medicine, University of Maryland Medical System, Baltimore, USA.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Angina, Unstable / radiography,  therapy*
Angioplasty, Transluminal, Percutaneous Coronary / instrumentation*
Combined Modality Therapy
Coronary Angiography
Coronary Thrombosis / therapy*
Creatine Kinase / blood
Electrocardiography
Equipment Design
Female
Fibrinolysis / drug effects
Heparin / administration & dosage*
Humans
Injections, Intralesional
Isoenzymes
Male
Middle Aged
Myocardial Infarction / radiography,  therapy
Prospective Studies
Thrombolytic Therapy / instrumentation*
Tissue Plasminogen Activator / administration & dosage*
Treatment Outcome
Chemical
Reg. No./Substance:
0/Isoenzymes; 9005-49-6/Heparin; EC 2.7.3.2/Creatine Kinase; EC 3.4.21.68/Tissue Plasminogen Activator

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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