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Noma S, Miyachi H, Fukuizumi I, Matsuda J, Sangen H, Kubota Y, Imori Y, Saiki Y, Hosokawa Y, Tara S, Tokita Y, Akutsu K, Shimizu W, Yamamoto T, Takano H. Adjunctive Catheter-Directed Thrombolysis during Primary PCI for ST-Segment Elevation Myocardial Infarction with High Thrombus Burden. J Clin Med 2022; 11:jcm11010262. [PMID: 35012003 PMCID: PMC8745791 DOI: 10.3390/jcm11010262] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 12/26/2021] [Accepted: 12/31/2021] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND High coronary thrombus burden has been associated with unfavorable outcomes in patients with ST-segment elevation myocardial infarction (STEMI), the optimal management of which has not yet been established. METHODS We assessed the adjunctive catheter-directed thrombolysis (CDT) during primary percutaneous coronary intervention (PCI) in patients with STEMI and high thrombus burden. CDT was defined as intracoronary infusion of tissue plasminogen activator (t-PA; monteplase). RESULTS Among the 1849 consecutive patients with STEMI, 263 had high thrombus burden. Moreover, 41 patients received t-PA (CDT group), whereas 222 did not receive it (non-CDT group). No significant differences in bleeding complications and in-hospital and long-term mortalities were observed (9.8% vs. 7.2%, p = 0.53; 7.3% vs. 2.3%, p = 0.11; and 12.6% vs. 17.5%, p = 0.84, CDT vs. non-CDT). In patients who underwent antecedent aspiration thrombectomy during PCI (75.6% CDT group and 87.4% non-CDT group), thrombolysis in myocardial infarction grade 2 or 3 flow rate after thrombectomy was significantly lower in the CDT group than in the non-CDT group (32.2% vs. 61.0%, p < 0.01). However, the final rates improved without significant difference (90.3% vs. 97.4%, p = 0.14). CONCLUSIONS Adjunctive CDT appears to be tolerated and feasible for high thrombus burden. Particularly, it may be an option in cases with failed aspiration thrombectomy.
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Affiliation(s)
- Satsuki Noma
- Division of Cardiovascular Intensive Care, Nippon Medical School Hospital, Tokyo 113-8603, Japan; (S.N.); (I.F.); (J.M.); (H.S.); (Y.I.); (Y.S.); (Y.H.); (S.T.); (Y.T.); (K.A.); (W.S.); (T.Y.)
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo 113-8603, Japan; (Y.K.); (H.T.)
| | - Hideki Miyachi
- Division of Cardiovascular Intensive Care, Nippon Medical School Hospital, Tokyo 113-8603, Japan; (S.N.); (I.F.); (J.M.); (H.S.); (Y.I.); (Y.S.); (Y.H.); (S.T.); (Y.T.); (K.A.); (W.S.); (T.Y.)
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo 113-8603, Japan; (Y.K.); (H.T.)
- Correspondence: hidep-@nms.ac.jp; Tel.: +81-3-3822-2131
| | - Isamu Fukuizumi
- Division of Cardiovascular Intensive Care, Nippon Medical School Hospital, Tokyo 113-8603, Japan; (S.N.); (I.F.); (J.M.); (H.S.); (Y.I.); (Y.S.); (Y.H.); (S.T.); (Y.T.); (K.A.); (W.S.); (T.Y.)
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo 113-8603, Japan; (Y.K.); (H.T.)
| | - Junya Matsuda
- Division of Cardiovascular Intensive Care, Nippon Medical School Hospital, Tokyo 113-8603, Japan; (S.N.); (I.F.); (J.M.); (H.S.); (Y.I.); (Y.S.); (Y.H.); (S.T.); (Y.T.); (K.A.); (W.S.); (T.Y.)
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo 113-8603, Japan; (Y.K.); (H.T.)
| | - Hideto Sangen
- Division of Cardiovascular Intensive Care, Nippon Medical School Hospital, Tokyo 113-8603, Japan; (S.N.); (I.F.); (J.M.); (H.S.); (Y.I.); (Y.S.); (Y.H.); (S.T.); (Y.T.); (K.A.); (W.S.); (T.Y.)
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo 113-8603, Japan; (Y.K.); (H.T.)
| | - Yoshiaki Kubota
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo 113-8603, Japan; (Y.K.); (H.T.)
| | - Yoichi Imori
- Division of Cardiovascular Intensive Care, Nippon Medical School Hospital, Tokyo 113-8603, Japan; (S.N.); (I.F.); (J.M.); (H.S.); (Y.I.); (Y.S.); (Y.H.); (S.T.); (Y.T.); (K.A.); (W.S.); (T.Y.)
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo 113-8603, Japan; (Y.K.); (H.T.)
| | - Yoshiyuki Saiki
- Division of Cardiovascular Intensive Care, Nippon Medical School Hospital, Tokyo 113-8603, Japan; (S.N.); (I.F.); (J.M.); (H.S.); (Y.I.); (Y.S.); (Y.H.); (S.T.); (Y.T.); (K.A.); (W.S.); (T.Y.)
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo 113-8603, Japan; (Y.K.); (H.T.)
| | - Yusuke Hosokawa
- Division of Cardiovascular Intensive Care, Nippon Medical School Hospital, Tokyo 113-8603, Japan; (S.N.); (I.F.); (J.M.); (H.S.); (Y.I.); (Y.S.); (Y.H.); (S.T.); (Y.T.); (K.A.); (W.S.); (T.Y.)
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo 113-8603, Japan; (Y.K.); (H.T.)
| | - Shuhei Tara
- Division of Cardiovascular Intensive Care, Nippon Medical School Hospital, Tokyo 113-8603, Japan; (S.N.); (I.F.); (J.M.); (H.S.); (Y.I.); (Y.S.); (Y.H.); (S.T.); (Y.T.); (K.A.); (W.S.); (T.Y.)
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo 113-8603, Japan; (Y.K.); (H.T.)
| | - Yukichi Tokita
- Division of Cardiovascular Intensive Care, Nippon Medical School Hospital, Tokyo 113-8603, Japan; (S.N.); (I.F.); (J.M.); (H.S.); (Y.I.); (Y.S.); (Y.H.); (S.T.); (Y.T.); (K.A.); (W.S.); (T.Y.)
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo 113-8603, Japan; (Y.K.); (H.T.)
| | - Koichi Akutsu
- Division of Cardiovascular Intensive Care, Nippon Medical School Hospital, Tokyo 113-8603, Japan; (S.N.); (I.F.); (J.M.); (H.S.); (Y.I.); (Y.S.); (Y.H.); (S.T.); (Y.T.); (K.A.); (W.S.); (T.Y.)
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo 113-8603, Japan; (Y.K.); (H.T.)
| | - Wataru Shimizu
- Division of Cardiovascular Intensive Care, Nippon Medical School Hospital, Tokyo 113-8603, Japan; (S.N.); (I.F.); (J.M.); (H.S.); (Y.I.); (Y.S.); (Y.H.); (S.T.); (Y.T.); (K.A.); (W.S.); (T.Y.)
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo 113-8603, Japan; (Y.K.); (H.T.)
| | - Takeshi Yamamoto
- Division of Cardiovascular Intensive Care, Nippon Medical School Hospital, Tokyo 113-8603, Japan; (S.N.); (I.F.); (J.M.); (H.S.); (Y.I.); (Y.S.); (Y.H.); (S.T.); (Y.T.); (K.A.); (W.S.); (T.Y.)
| | - Hitoshi Takano
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo 113-8603, Japan; (Y.K.); (H.T.)
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Kato M, Dote K, Sasaki S, Kagawa E, Nakano Y, Watanabe Y, Higashi A, Itakura K, Ochiumi Y, Takiguchi Y. Presentations of acute coronary syndrome related to coronary lesion morphologies as assessed by intravascular ultrasound and optical coherence tomography. Int J Cardiol 2013; 165:506-11. [DOI: 10.1016/j.ijcard.2011.09.032] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2011] [Accepted: 09/06/2011] [Indexed: 10/17/2022]
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Kato M, Dote K, Naganuma T, Sasaki S, Ueda K, Okita M, Watanabe Y, Kajikawa M, Yokoyama H, Higashi A. Clinical Predictors of Culprit Plaque Rupture Assessed on Intravascular Ultrasound in Acute Coronary Syndrome. Circ J 2010; 74:1936-42. [DOI: 10.1253/circj.cj-10-0086] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Masaya Kato
- Department of Cardiology, Hiroshima City Asa Hospital
| | - Keigo Dote
- Department of Cardiology, Hiroshima City Asa Hospital
| | - Toru Naganuma
- Department of Cardiology, Hiroshima City Asa Hospital
| | - Shota Sasaki
- Department of Cardiology, Hiroshima City Asa Hospital
| | - Kentaro Ueda
- Department of Cardiology, Hiroshima City Asa Hospital
| | - Misa Okita
- Department of Cardiology, Hiroshima City Asa Hospital
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Matsunobu T, Watanabe M, Bou H, Takahashi N, Tokunaga A, Tajiri T. Acute pulmonary thromboembolism after distal gastrectomy: an appraisal of the guidelines for preventing pulmonary thromboembolism/deep vein thrombosis. J NIPPON MED SCH 2008; 75:175-80. [PMID: 18648177 DOI: 10.1272/jnms.75.175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
We report a case of acute pulmonary thromboembolism after gastrectomy. A 67-year-old woman was found to have gastric cancer and a giant lipoma in the ascending colon. We performed distal gastrectomy and enucleation of the ascending colon lipoma. On postoperative day 9, an acute pulmonary thromboembolism developed, and thrombolytic therapy was urgently performed. The 2004 Japanese guidelines for preventing pulmonary thromboembolism/deep vein thrombosis are discussed in relation to the present case.
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Affiliation(s)
- Tetsuro Matsunobu
- Surgery for Organ Function and Biological Regulation, Graduate School of Medicine, Nippon Medical School, Japan.
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Gupta R, Rahman MA, Uretsky BF, Schwarz ER. Left main coronary artery thrombus: a case series with different outcomes. J Thromb Thrombolysis 2005; 19:125-31. [PMID: 16052304 DOI: 10.1007/s11239-005-1924-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Left main coronary artery (LMCA) thrombosis with acute myocardial infarction is an uncommon condition with an extremely high mortality. The small number of reported cases prevents the development of an evidence-based approach. Hence there are no clear-cut guidelines describing the best management approach for this condition. We describe our experience with six patients who presented with LMCA thrombosis and discuss the epidemiology, etiology and management options available for this high-risk subgroup.
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Affiliation(s)
- Rajiv Gupta
- Division of Cardiology, Department of Internal Medicine, The University of Texas Medical Branch, Galveston, Texas, 77555-0553, USA
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Kelly RV, Crouch E, Krumnacher H, Cohen MG, Stouffer GA. Safety of adjunctive intracoronary thrombolytic therapy during complex percutaneous coronary intervention: Initial experience with intracoronary tenecteplase. Catheter Cardiovasc Interv 2005; 66:327-32. [PMID: 16208711 DOI: 10.1002/ccd.20521] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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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Affiliation(s)
- Robert V Kelly
- Division of Cardiology, Cardiac Catheterization Laboratory, University of North Carolina, Chapel Hill, North Carolina 27599, USA
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Tanabe Y, Itoh E, Nakagawa I, Suzuki K. Pulse-spray thrombolysis in acute myocardial infarction caused by thrombotic occlusion of an ectatic coronary artery. Circ J 2002; 66:207-10. [PMID: 11999650 DOI: 10.1253/circj.66.207] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Pulse-spray thrombolysis was performed in 2 patients with acute myocardial infarction (AMI) caused by thrombotic occlusion of coronary artery ectasia. Case 1, a 66-year-old woman with an inferior AMI underwent emergency coronary arteriography, which revealed occlusion of an ectatic right coronary artery. Primary balloon angioplasty failed to reestablish distal flow. Urokinase was administered through the pulse-spray infusion catheter (UltraFuse) and intravenous recombinant tissue plasminogen activator was also administered. Angiographic disappearance of the thrombus was observed within 30 min of starting the infusion, and there was only mild irregularity in the ectatic coronary artery. Case 2, a 45-year-old man with an inferior AMI underwent emergency coronary arteriography, which revealed occlusion of an ectatic right coronary artery. TIMI-3 flow was soon obtained after administration of 480,000 units of urokinase through the pulse-spray infusion catheter. There was diffuse right coronary ectasia without angiographic evidence of coronary stenosis. Coronary ectasia sometimes develops into AMI without the coexistence of coronary stenosis. Because a massive thrombus plays a major role, pulse-spray thrombolysis is a possible treatment in coronary artery ectasia with thrombotic occlusion.
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Affiliation(s)
- Yasuhiko Tanabe
- Department of Cardiology, Niigata Prefectural Shibata Hospital, Shibata, Japan
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Ishibashi F, Saito T, Hokimoto S, Noda K, Moriyama Y, Oshima S. Combined revascularization strategy for acute myocardial infarction in patients with intracoronary thrombus: preceding intracoronary thrombolysis and subsequent mechanical angioplasty. JAPANESE CIRCULATION JOURNAL 2001; 65:251-6. [PMID: 11316117 DOI: 10.1253/jcj.65.251] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Thrombus in the infarct-related artery is one of the limitations for flow restoration in primary percutaneous transluminal coronary angioplasty (PTCA) treatment for acute myocardial infarction (AMI). The present study investigated the benefit of preceding intracoronary thrombolysis (ICT) by retrospectively analyzing acute phase flow restoration in 80 AMI patients with intracoronary thrombus: 40 undergoing primary PTCA alone (primary PTCA group) and 40 treated with preceding ICT plus PTCA (combined group). Acute phase Thrombolysis in Myocardial Infarction (TIMI) grade flow was as follows: TIMI 0/1: 35.0% vs 12.5% for the primary PTCA group and the combined group, p=0.06; TIMI 2: 7.5% vs 15.0%, p=NS; TIMI 3: 57.5% vs 72.5%, p=NS). In the subgroup analysis, it was also less in the combined group among 33 patients with a left anterior descending coronary artery (LAD) lesion (42.1 % vs 7.1%, p=0.08), but not among the remaining 47 with either a right coronary artery or left circumflex artery lesion. The combined therapy may potentially provide better acute phase flow restoration in AMI patients with an intracoronary thrombus in a LAD lesion.
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Affiliation(s)
- F Ishibashi
- Cardiovascular Division, Kumamoto Central Hospital, Japan
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Saito T, Hokimoto S, Ishibashi F, Noda K, Oshima S. Pulse infusion thrombolysis (PIT) for large intracoronary thrombus: preventive effect against the 'no flow' phenomenon in revascularization therapy for acute myocardial infarction. JAPANESE CIRCULATION JOURNAL 2001; 65:94-8. [PMID: 11216832 DOI: 10.1253/jcj.65.94] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Because large thrombus is a limitation for revascularization in acute myocardial infarction (AMI), the present study evaluated the effectiveness of pulse infusion thrombolysis (PIT) in patients with an AMI with a large (>15 mm) coronary thrombus, focusing on the occurrence of the 'no flow' phenomenon. The retrospective study compared patients treated before (1988-95; Group A, n=74) and after (1996-99; Group B, n=40) the use of PIT, using the following parameters: lesion success (<50% stenosis during 30-min observation), procedural success (lesion success plus TIMI grade 3 flow), procedural no flow (TIMI grade 0 flow during the procedure with 'back and forth movement' of contrast dye after lesion success), persistent no flow (consistent no flow without any flow improvement at the final visualization despite intensive treatment), reocclusion rate and in-hospital death. Group B was significantly better than Group A in procedural success (90% vs 66%; p=0.005), procedural 'no flow' (51% vs 15%; p<0.001), and persistent 'no flow' (34% vs 10%; p<0.05). Subgroup comparison was performed among the following groups: Direct-BA group (n=44): treated with mechanical angioplasty alone; ICT-BA group (n=40): treated with prior intracoronary thrombolysis and angioplasty; and PIT-BA group (n=30): treated with PIT and angioplasty. There were no differences in thrombus length and lesion success among these 3 groups. Procedural success was best achieved in PIT-BA: 97% vs 52% for Direct-BA (p=0.003) and 68% for ICT-BA (p=0.009). Procedural 'no flow' was least in PIT-BA: 50% vs 3.3% for Direct-BA (p=0.003) and 25% vs 3.3% for ICT-BA (p=0.042). Persistent 'no flow' was less frequent in PIT-BA than Direct-BA: 32% vs 3.3% (p=0.009). However, the difference between ICT-BA and Direct-BA was insignificant: 13% vs 3.3% (p=0.53). There were no differences in reocclusion rate and in-hospital death among the 3 subgroups. And there were no differences between Direct-BA and ICT-BA in any parameters. PIT was effective in preventing 'no flow' in the mechanical revasculalization for AMI especially those cases with a large thrombus.
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Affiliation(s)
- T Saito
- Cardiovascular Division, Kumamoto Central Hospital, Kumamoto City, Japan.
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