Lesion-directed administration of alteplase with intracoronary heparin in patients with unstable angina and coronary thrombus undergoing angioplasty.

Journal Article (Journal Article;Multicenter Study)

Percutaneous coronary revascularization in patients with unstable angina and coronary thrombus carries a high complication rate. A new strategy to reduce thrombus burden before revascularization was tested in a multicenter prospective trial. Patients with unstable angina and coronary thrombus (n = 45) received alteplase through an infusion catheter at the proximal aspect of the target lesion and concomitant intracoronary heparin via a standard guiding catheter. Angiography was performed before and alter lesion-directed therapy and post-intervention. Systemic fibrinogen depletion and thrombin activation were not observed, while fibrinolysis was evident for > or = 4 hr after treatment. Target lesion stenosis did not change significantly after lesion-directed therapy, but thrombus score was reduced, particularly among patients who had large thrombi (mean 2.2 vs. 1.6, P = 0.02). Revascularization was successful in 89% of patients. Median final stenosis was 30% and mean final thrombus score was 0.4. Complications included recurrent ischemia (11%), MI (7%), abrupt closure (7%), severe bleeding (4%), and repeat emergency angioplasty (2%). Patients with overt thrombus appeared to derive the most angiographic benefit from lesion-directed alteplase plus intracoronary heparin. Later revascularization was highly successful. This strategy may be a useful adjunct to percutaneous revascularization for patients with unstable angina and frank intracoronary thrombus.

Full Text

Duke Authors

Cited Authors

  • Gurbel, PA; Navetta, FI; Bates, ER; Muller, DW; Tenaglia, AN; Miller, MJ; Muhlstein, B; Hermiller, JB; Davidson, CJ; Aguirre, FV; Beauman, GJ; Berdan, LG; Leimberger, JD; Bovill, EG; Christenson, RH; Ohman, EM

Published Date

  • April 1996

Published In

Volume / Issue

  • 37 / 4

Start / End Page

  • 382 - 391

PubMed ID

  • 8721695

International Standard Serial Number (ISSN)

  • 0098-6569

Digital Object Identifier (DOI)

  • 10.1002/(SICI)1097-0304(199604)37:4<382::AID-CCD8>3.0.CO;2-7


  • eng

Conference Location

  • United States