Safety of adjunctive intracoronary thrombolytic therapy during complex percutaneous coronary intervention: Initial experience with intracoronary tenecteplase

Robert V. Kelly, Eron Crouch, Heather Krumnacher, Mauricio G Cohen, George A. Stouffer

Research output: Contribution to journalArticle

32 Citations (Scopus)

Abstract

Intracoronary thrombus is associated with increased risk of in-laboratory vessel closure, recurrent myocardial infarction (MI), urgent vessel revascularization, and death. There is a lack of consensus on what represents the ideal treatment for patients with thrombotic complications during percutaneous coronary intervention (PCI), but the development of newer thrombolytic agents with increased fibrin specificity and longer half-life provides a potentially useful treatment option. In this study, the safety and efficacy of intracoronary tenecteplase (TNK) was evaluated in 34 patients (22 with acute ST elevation MI, 4 with rescue PCI, 6 with non-ST elevation MI, and 2 during elective PCI) who developed no-reflow, distal embolization, or visible intracoronary thrombus during PCI. The mean age was 57 years, 76% were Caucasian, and there were 14 women and 20 men. Cardiogenic shock was present in seven (21%) patients at baseline. All patients were being treated with aspirin and either unfractionated heparin (33 patients) or bivalrudin. Glycoprotein IIb/IIIa inhibitors were used in 76% of patients. Intracoronary TNK was used at a mean dose of 10.2 ± 5.2 mg (median, 10 mg; range, 5-25 mg). There was one TIMI major bleeding event and three TIMI minor bleeding events. The mean hematocrit measured the morning following PCI was 35.5% ± 4.9% in patients receiving TNK and 36.5% ± 4.4% in a randomly selected sample of 150 consecutive patients undergoing PCI (P = 0.25). In conjunction with mechanical intervention, TNK was successful at dissolving angiographic thrombus and/or improving flow in 91% of patients. In conclusion, intracoronary TNK is safe and well tolerated in patients who develop thrombotic complications during complex PCI.

Original languageEnglish
Pages (from-to)327-332
Number of pages6
JournalCatheterization and Cardiovascular Interventions
Volume66
Issue number3
DOIs
StatePublished - Nov 1 2005
Externally publishedYes

Fingerprint

Thrombolytic Therapy
Percutaneous Coronary Intervention
Safety
Thrombosis
tenecteplase
Hemorrhage
Platelet Glycoprotein GPIIb-IIIa Complex
Fibrinolytic Agents
Cardiogenic Shock
Fibrin
Hematocrit
Aspirin
Half-Life
Heparin
Myocardial Infarction

Keywords

  • Distal embolization
  • Intracoronary thrombus
  • No-reflow
  • Percutaneous coronary intervention
  • Thrombolytic therapy

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging

Cite this

Safety of adjunctive intracoronary thrombolytic therapy during complex percutaneous coronary intervention : Initial experience with intracoronary tenecteplase. / Kelly, Robert V.; Crouch, Eron; Krumnacher, Heather; Cohen, Mauricio G; Stouffer, George A.

In: Catheterization and Cardiovascular Interventions, Vol. 66, No. 3, 01.11.2005, p. 327-332.

Research output: Contribution to journalArticle

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abstract = "Intracoronary thrombus is associated with increased risk of in-laboratory vessel closure, recurrent myocardial infarction (MI), urgent vessel revascularization, and death. There is a lack of consensus on what represents the ideal treatment for patients with thrombotic complications during percutaneous coronary intervention (PCI), but the development of newer thrombolytic agents with increased fibrin specificity and longer half-life provides a potentially useful treatment option. In this study, the safety and efficacy of intracoronary tenecteplase (TNK) was evaluated in 34 patients (22 with acute ST elevation MI, 4 with rescue PCI, 6 with non-ST elevation MI, and 2 during elective PCI) who developed no-reflow, distal embolization, or visible intracoronary thrombus during PCI. The mean age was 57 years, 76{\%} were Caucasian, and there were 14 women and 20 men. Cardiogenic shock was present in seven (21{\%}) patients at baseline. All patients were being treated with aspirin and either unfractionated heparin (33 patients) or bivalrudin. Glycoprotein IIb/IIIa inhibitors were used in 76{\%} of patients. Intracoronary TNK was used at a mean dose of 10.2 ± 5.2 mg (median, 10 mg; range, 5-25 mg). There was one TIMI major bleeding event and three TIMI minor bleeding events. The mean hematocrit measured the morning following PCI was 35.5{\%} ± 4.9{\%} in patients receiving TNK and 36.5{\%} ± 4.4{\%} in a randomly selected sample of 150 consecutive patients undergoing PCI (P = 0.25). In conjunction with mechanical intervention, TNK was successful at dissolving angiographic thrombus and/or improving flow in 91{\%} of patients. In conclusion, intracoronary TNK is safe and well tolerated in patients who develop thrombotic complications during complex PCI.",
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