Intracoronary recombinant tissue-type plasminogen activator (rt-PA).

Abstract

Intracoronary rt-PA has been used to treat patients with acute myocardial infarction primarily, after failure of intravenous thrombolytic therapy, and when angioplasty has not been technically possible. It has also been used to treat thrombotic closure complicating angioplasty, to treat nonocclusive thrombosis observed during angioplasty, and to pretreat patients with nonacute total occlusions before angioplasty. Intracoronary administration has the potential of providing high local concentrations for a given dose level and may allow lower total doses for the same degree of efficacy. More controlled data are needed on appropriate patient selection, angiographic and clinical endpoints, dose level and regimen, and comparable efficacy of rt-PA and other thrombolytic agents. However, the use of intracoronary rt-PA should be considered when intracoronary thrombus is evident and this route of administration is available.