Intra-Thrombus Lytic Therapy May Reduce Complications Of Primary Percutaneous Intervention In Acute Myocardial Infarction And Massive Intracoronary Thrombus Not Treated With Glycoprotein IIb/IIIa Antagonists

Abstract

Aims: A proportion of acute myocardial infarction (AMI) patients suffer from insufficient coronary reflow, even though percutaneous coronary intervention (PCI) with a Guardwire Plus System® (GPS) has been performed. Therefore, we investigated the clinical usefulness of simultaneously using both intra-thrombus lytic therapy (ITLT) and the GPS in inferior AMI patients. Methods: Forty-four inferior AMI patients with massive evident coronary thrombus detected on coronary angiography were enrolled. Twelve of the 44 underwent primary PCI using ITLT with tissue plasminogen activator via an FC catheter®. Primary coronary stenting was carried out with the GPS alone (Group 1; n=32), or ITLT alone (Group 2; n=5) or ITLT followed by repetitive aspiration of the thrombus burden using the GPS (Group 3; n=7). Results: Eighteen (56%) in group1 had significant complications (distal emboli, n=7; prolonged hypotension, n=4; malignant arrhythmia, n=8; side branch occlusion, n=3; worsened chest pain, n=9). Two of the 7 with distal coronary emboli showed insufficient coronary flow even after additional treatments. In group 2, all patients showed complications (transient distal emboli, n=2; hypotension, n=1; bradycardia, n=1; worsened chest pain, n=3). However, none in group 3 showed significant complications except for transient distal coronary embolisation in 2. Conclusion: In spite of our small study cohort, we showed that intra-thrombus lytic therapy using an FC catheter followed by PCI with a GPS might reduce complications in patients with inferior AMI with massive evident thrombus.