Thrombolytics clear the way for coronary angioplasty In patients with large intravascular thrombi
In patients with unstable angina, an intravascular thrombus can make coronary angioplasty difficult or impossible. Therefore , the effect of thrombolytic agents on nonacute large thrombi was retrospectively assessed in 14 such patients. Intracoronary or intragraft streptokinase 80 000-650000 U (n= 12), or IV alteplase 100mg (2) was used before angiography; patients also received aspirin and dipyridamole.
Clot dissolution was considerable (> 75"10) in 5 patients and complete in 3 patients, resulting in a 28"'/", increase in luminal diameter and normalisation of previously absent distal flow. These patients were able to undergo successful coronary angioplasty . Five of the 8 successfully-treated patients had thrombi that were in saphenous vein grafts. Maximal thrombolytic effect was evident after the delayed imaging (mean 1.6 days later). Six patients failed to respond to thrombolysis, although 2 subsequently underwent successful coronary angioplasty.
' ... Thrombolytic therapy can be an efficacious adjunct to PTCA [percutaneous translumlnal coronary angioplastyJ in patients with anglographic ellidence of intrallascular thrombus and unstable angina of up to selleral weeks' duration.' Grill HP. Brinker JA Nonacute thrombotytlc therapy an ad,unct to coronary angloplasty In patients with large Intravascular thrombi American Heart Journal 118 662667 . Oct 1989 '5