Demonstration of recanalized left coronary artery after thrombolysis by transthoracic echocardiography
Anne Anjaneyulu1, Penumatsa Raghavaraju, Raghu Krishnaswamy
1Division of Cardiology, Care Hospital, Hyderabad 500034, India. anjan_anne@yahoo.com
Insights
Transthoracic echocardiography (TTE) can bedside demonstrate coronary artery reperfusion after thrombolysis. This technique helps identify critical narrowings and guides treatment for acute myocardial infarction.
Area of Science:
- Cardiovascular Imaging
- Interventional Cardiology
- Echocardiography
Background:
- Coronary artery recanalization is typically confirmed via angiography.
- Early reperfusion assessment using transthoracic echocardiography (TTE) post-thrombolysis is crucial for risk stratification and intervention timing.
Purpose of the Study:
- To evaluate the feasibility of bedside demonstration of coronary artery reperfusion using TTE after thrombolytic therapy.
- To assess the utility of TTE in identifying critical coronary artery narrowings in patients with acute myocardial infarction.
Main Methods:
- 12 patients with acute anterior myocardial infarction receiving thrombolysis were studied.
- Echocardiographic Doppler evaluation of coronary arteries (left main, LAD, circumflex) was performed before, during, and after thrombolysis.
- Coronary flow and velocity measurements by TTE were compared with subsequent coronary angiography.
Main Results:
- TTE successfully assessed blood flow in 9 patients.
- Post-thrombolysis, LAD flow was demonstrated in 7 patients within 6 hours.
- TTE accurately correlated with angiography in identifying critical narrowings and occlusions in LAD.
Conclusions:
- Bedside demonstration of recanalized coronary arteries after thrombolysis is feasible with TTE.
- TTE's ability to locate critical narrowings aids in subsequent treatment decisions for acute myocardial infarction.
Background:
Demonstration of recanalized coronary artery is mostly done by angiographic techniques. Early bedside demonstration of reperfusion after thrombolysis by transthoracic echocardiography (TTE) has important implications in the subsequent risk stratification and timing of coronary interventions.
Methods:
In this study, 12 patients with acute anterior myocardial infarction who received thrombolytic therapy were studied. Echocardiographic Doppler evaluation of left main coronary artery, proximal left anterior descending coronary artery (LAD), and proximal left circumflex coronary artery were studied before, during, and after thrombolytic therapy. Coronary flow in these arterial segments was assessed both by color flow and velocity measurements. These results were compared with coronary angiographic studies performed within 30 minutes to 48 hours of thrombolysis.
Results:
Blood flow in left main coronary artery, LAD, and left circumflex coronary artery could be assessed in 9 patients. There was no demonstrable flow in LAD in 6 patients before thrombolysis. In 7 patients flow could be demonstrated in LAD after thrombolysis within 15 minutes to 6 hours. The peak flow velocity in LAD at a localized area of turbulence postthrombolysis varied from 1.8 to 4.5 m/s. One patient showed mosaic color flow in left main coronary artery with a peak velocity of 1.9 m/s before thrombolysis that improved to a laminar flow with a peak velocity of 1.0 m/s after thrombolysis. Two patients showed normal flow in proximal LAD, but no flow in mid-LAD. Two patients did not show any flow in LAD even after 12 hours of thrombolysis. There was good correlation of site of critical narrowing in LAD by TTE with coronary angiography in 6 patients. In 3 patients absent flow in mid-LAD by TTE correlated with total occlusion of either proximal (one patient) or mid-LAD (two patients).
Conclusions:
Demonstration of recanalized infarct-related left coronary artery soon after thrombolytic therapy is feasible. Locating the actual site of critical narrowing at bedside by TTE has important implications in the subsequent treatment of patients with acute anterior wall myocardial infarction.
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