Selective infusion of thrombolytic therapy in the acute myocardial infarct-related coronary artery as an alternative to rescue percutaneous transluminal coronary angioplasty

Paul A. Gurbel, Charles J. Davidson, E. Magnus Ohman, Jack E. Smith, Richard S. Stack

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Abstract

The management of patients with acute myocardial infarction in whom reperfusion has been unsuccessful with standard dose thrombolytic therapy remains controversial.1 Rescue percutaneous transluminal coronary angioplasty (PTCA) has been associated with a high reocclusion rate after failed intravenous tissue plasminogen activator (TPA) with accompanying high morbidity and mortality.2 It has been postulated that PTCA in the setting of thrombolytic therapy may induce subintimal hemorrhage, which may lead to reocclusion.3 As an alternative method for restoring coronary patency after failed intravenous TPA, we describe the results of selective intracoronary injection of a longer acting thrombolytic agent, without adjunctive PTCA, using an infusion catheter that provides a mechanical jet effect to disrupt the coronary thrombus. Use of this coronary thrombolytic technique was successful in each patient after failed intravenous TPA.

Original languageEnglish (US)
Pages (from-to)1021-1023
Number of pages3
JournalThe American Journal of Cardiology
Volume66
Issue number12
DOIs
StatePublished - Oct 15 1990

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ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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