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


Journal Article

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

Pubmed Central 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