| Site-specific intracoronary thrombolysis with urokinase-coated hydrogel balloons: acute and follow-up studies in 95 patients. | |
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MedLine Citation:
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PMID: 9213022 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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Conventional balloon angioplasty in the presence of intracoronary thrombus is associated with an elevated risk for acute myocardial infarction, emergency bypass surgery, and death. The purpose of this study was to assess the safety and efficacy of a new technique to treat thrombus-containing stenoses consisting of the local delivery of urokinase directly to the site of intraluminal clot with hydrogel-coated balloons. Ninety-five patients with angiographically apparent intracoronary thrombus were treated with urokinase-coated hydrogel balloons either prior to (n = 74) or following (n = 21) conventional balloon angioplasty. Clinical diagnoses for the study group included acute myocardial infarction in 50 patients, postinfarction angina in 23 patients, and unstable angina in 22 patients. All hydrogel balloons were initially coated with urokinase by immersing the inflated balloon in a concentrated Abbokinase solution (50,000 units/ml) for 60 s. All patients were subsequently treated with drug-coated balloons using a balloon:artery ratio of 1:1, a mean of 2.2 +/- 1.2 inflations, and a mean total inflation time of 7.5 +/- 4.9 min. Use of urokinase-coated balloons resulted in angiographic disappearance of intracoronary thrombus in 78 patients, improvement in 14, and no change in the remaining 3 patients. Following hydrogel balloon use for the entire 95 patients, TIMI flow increased from 1.4 +/- 1.2 to 2.9 +/- 0.4, minimal lumen diameter increased from 0.4 +/- 0.4 to 2.0 +/- 0.6 mm, and thrombus score decreased from 2.0 +/- 0.9 to 0.2 +/- 0.6 (all P < 0.01). Procedural and early in-hospital complications were noted in 7 of the 95 patients (7.4%) and included abrupt closure in 3 patients, distal embolization in 1 patient, no reflow in 1 patient, sidebranch occlusion in 1 patient, and late closure in 1 patient. Two of the 3 patients with abrupt closure and the single patient with late closure required intracoronary stenting to maintain vessel patency. Two of these 7 patients sustained small myocardial infarctions, although no patient required emergency bypass surgery or experienced a procedural death. Late clinical follow-up (mean = 8.3 +/- 6.6 months; range = 2 wk to 29 mo) demonstrated adverse recurrent events in 29 of the 95 patients (30.5%), including death (n = 5), myocardial infarction (n = 2), and recurrence of angina (n = 22). The results of this study suggest that intracoronary thrombolysis can be safely and rapidly achieved by using limited quantities of urokinase delivered directly to the site of intraluminal clot with hydrogel balloons. Use of this technique may result in improved acute outcomes in comparison with conventional techniques currently being used to treat thrombus-containing stenoses. |
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Authors:
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J J Glazier; J A Hirst; F J Kiernan; D B Fram; A M Eldin; C A Primiano; J F Mitchel; R G McKay |
Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Catheterization and cardiovascular diagnosis Volume: 41 ISSN: 0098-6569 ISO Abbreviation: Cathet Cardiovasc Diagn Publication Date: 1997 Jul |
Date Detail:
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Created Date: 1997-08-21 Completed Date: 1997-08-21 Revised Date: 2008-11-21 |
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: 246-53 Citation Subset: IM |
Affiliation:
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Department of Cardiology, Hartford Hospital, University of Connecticut 06102, USA. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Angina Pectoris / drug therapy, mortality, radiography Angina, Unstable / drug therapy, mortality, radiography Angioplasty, Transluminal, Percutaneous Coronary / instrumentation* Coronary Angiography / drug effects Coronary Circulation / drug effects Coronary Thrombosis / drug therapy*, mortality, radiography Drug Delivery Systems / instrumentation* Equipment Design Female Fibrinolytic Agents / administration & dosage* Humans Hydrogel Male Middle Aged Myocardial Infarction / drug therapy, mortality, radiography Polyethylene Glycols* Recurrence Surface Properties Survival Rate Thrombolytic Therapy / instrumentation* Urokinase-Type Plasminogen Activator / administration & dosage* |
| Chemical | |
Reg. No./Substance:
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0/Fibrinolytic Agents; 0/Polyethylene Glycols; 25852-47-5/Hydrogel; EC 3.4.21.73/Urokinase-Type Plasminogen Activator |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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