| Lesion-directed administration of alteplase with intracoronary heparin in patients with unstable angina and coronary thrombus undergoing angioplasty. | |
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MedLine Citation:
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PMID: 8721695 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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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:
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Type: Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: Catheterization and cardiovascular diagnosis Volume: 37 ISSN: 0098-6569 ISO Abbreviation: Cathet Cardiovasc Diagn Publication Date: 1996 Apr |
Date Detail:
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Created Date: 1996-09-17 Completed Date: 1996-09-17 Revised Date: 2006-11-15 |
Medline Journal Info:
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Nlm Unique ID: 7508512 Medline TA: Cathet Cardiovasc Diagn Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 382-91 Citation Subset: IM |
Affiliation:
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Department of Medicine, University of Maryland Medical System, Baltimore, USA. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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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:
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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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