Utilidad de la infusión intracoronaria de alteplase con microcatéter en el síndrome coronario agudo

Abstract

The management of intracoronary thrombus remains a challenge to the interventional cardiologist. Continuous thrombus formation, inadequate assessment of vessel diameter and plaque length, and distal embolization are adverse factors in this setting. In this paper, we present a novel strategy for coronary thrombus management with intracoronary alteplase using a microcatheter at a 1 mg/h dose for 12 hours. Sixteen patients were assigned to alteplase infusion and 15 to the conventional strategy. In the alteplase group, 50% of patients had TIMI 0 thrombus, versus 40% with TIMI 2 thrombus in the conventional group. In the alteplase group, eight stents were used, compared with 22 stents in the conventional group. The mean stent length was 18.4 ± 2.84 mm in the alteplase group and 21.45 ± 3.09 mm in the conventional group. No no-reflow cases were observed in the alteplase group, versus four cases in the conventional group. There were no hemorrhagic complications in either group. This method may be a valid strategy for the management of coronary thrombus.