Intracoronary arterial retrograde thrombolysis with percutaneous coronary intervention: a novel use of thrombolytic to treat acute ST-segment elevation myocardial infarction.

Content Provider	Europe PMC
Author	Tian, Jin-Wen Zhu, Mei Wang, Feng-Qi Li, Ke Zhou, Chao-Fei Li, Bo Wang, Min Deng, Jue-Lin Jiang, Bo Bai, Jing Guo, Yi Jin, Rong-Jie Zhang, Zhao Lin, Ying Wang, Ji-Hang Zhao, Shi-Hao Shen, Ming-Zhi
Copyright Year	2019
Abstract	BackgroundClearance of coronary arterial thrombosis is necessary in patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing urgent percutaneous coronary intervention (PCI). There is currently no highly-recommended method of thrombus removal during interventional procedures. We describe a new method for opening culprit vessels to treat STEMI: intracoronary arterial retrograde thrombolysis (ICART) with PCI.Methods & ResultsEight patients underwent ICART. The guidewire was advanced to the distal coronary artery through the occlusion lesion. Then, we inserted a microcatheter into the distal end of the occluded coronary artery over the guidewire. Urokinase (5–10 wu) mixed with contrast agents was slowly injected into the occluded section of the coronary artery through the microcatheter. The intracoronary thrombus gradually dissolved in 3–17 min, and the effect of thrombolysis was visible in real time. Stents were then implanted according to the characteristics of the recanalized culprit lesion to achieve full revascularization. One patient experienced premature ventricular contraction during vascular revascularization, and no malignant arrhythmias were seen in any patient. No reflow or slow flow was not observed post PCI. Thrombolysis in myocardial infarction flow grade and myocardial blush grade post-primary PCI was 3 in all eight patients. No patients experienced bleeding or stroke.ConclusionsICART was accurate and effective for treating intracoronary thrombi in patients with STEMI in this preliminary study. ICART was an effective, feasible, and simple approach to the management of STEMI, and no intraprocedural complications occurred in any of the patients. ICART may be a breakthrough in the treatment of acute STEMI.
ISSN	16715411
Journal	Journal of Geriatric Cardiology : JGC
Volume Number	16
PubMed Central reference number	PMC6612613
Issue Number	6
PubMed reference number	31308838
DOI	10.11909/j.issn.1671-5411.2019.06.004
Language	English
Publisher	Science Press
Publisher Date	2019-06-01
Access Restriction	Open
Rights License	This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 Unported License, which allows readers to alter, transform, or build upon the article and then distribute the resulting work under the same or similar license to this one. The work must be attributed back to the original author and commercial use is not permitted without specific permission. Institute of Geriatric Cardiology
Subject Keyword	ST elevation myocardial infarction Therapeutic thrombolysis Thrombus Urokinase
Content Type	Text
Resource Type	Article
Subject	Geriatrics and Gerontology Cardiology and Cardiovascular Medicine