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Intracoronary thrombus: chronic urokinase infusion and evaluation with intravascular ultrasound
1Department of Internal Medicine, Ochsner Medical Institutions, New Orleans, Louisiana 70121.
Insights
Intracoronary urokinase infusion can treat coronary artery thrombi. However, both angiography and intravascular ultrasound may inaccurately assess residual thrombus after treatment.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Thrombosis Research
Background:
- Percutaneous coronary interventions (PCI) are challenged by intraluminal thrombi.
- Effective thrombolysis is crucial for successful PCI outcomes.
Observation:
- A case study involving prolonged intracoronary urokinase infusion for coronary artery thrombus.
- Intravascular ultrasound (IVUS) and angiography were used for assessment before and after atherectomy.
Findings:
- Both conventional angiography and IVUS proved unreliable in detecting residual thrombus post-thrombolysis.
- Discrepancies highlight limitations in current imaging modalities for thrombus assessment.
Implications:
- Revising diagnostic strategies for residual thrombus after thrombolysis is necessary.
- Further research into advanced imaging techniques for accurate thrombus burden assessment is warranted.
Abstract:
Percutaneous revascularization of coronary arteries with intraluminal thrombi is a clinical problem. We report a patient in whom we administered prolonged infusion of intracoronary urokinase and then assessed the stenosis with intravascular ultrasound before and after atherectomy. We found both angiography and intravascular ultrasound to be misleading in determining the presence of residual thrombus after thrombolysis.