Abstract 12579: Intracoronary Thrombolysis, an Option in Coronary Arteries With Unique Characteristics: A Case Series Report

Abstract

Cases Description: Case 1: A 47-year-old male with inferior ST-segment Elevation Myocardial Infarction (STEMI). Percutaneous Coronary Intervention (PCI), showed an ectasic Right Coronary Artery (RCA) with an occlusive thrombus in mid-distal segment, TIMI 0. Thromboaspiration was not successful, proceeding to use intracoronary (IC) Alteplase 15mg. 72 hours later, PCI showed a RCA without stenosis, TIMI 2. Intravascular Ultrasound (IVUS) was used, showing no plaques or dissection. Discharged with Rivaroxaban 20mg QD and Acetilsalicylic acid (ASA) 100mg QD. Case 2: A 38-year-old male, with previous PCI and 1 stent in Anterior Descending Artery (ADA); arrives with STEMI. PCI showed a ADA non-occlusive intrastent thrombus, TIMI 2. IC Alteplase 15mg was used. After 72 hours, PCI identified the ADA with TIMI 3 flow. IVUS and Optical Coherence Tomography (OCT) showed a mild intrastent thrombus and proximal infraexpansion of previous stent. Proximal and medial segments were dilated, and 1 stent was placed distal. IVUS showed adequate expansion. Discharged with Apixaban 5mg BID and Clopidogrel 75mg QD. Case 3: A 64-year-old male, with inferior STEMI. PCI shows an ectasic ADA with a proximal and medial segment thrombus, TIMI 2. Tromboaspiration and posterior IC Alteplase 15mg were used, with TIMI 3 result. PCI 24 hours later, shows the ADA with TIMI 3 flow. IVUS identifies that no angioplasty was needed. Discharged with Ticagrelor 90mg BID and ASA QD. Discussion: IC thrombolysis is a useful method in primary PCI, where there is no favorable anatomy or massive IC thrombus. These cases show the utility of using IC imaging to evaluate the anatomy and thrombotic content of angiographic lesions. There is no consensus in the chronic anticoagulation/antithrombotic management after IC thrombolysis.