Combined, superselective pharmacological management of large coronary thrombus burden

Area of Science:

• Interventional Cardiology
• Thrombosis Management
• Vascular Medicine

Background:

• Percutaneous coronary intervention (PCI) in high thrombus burden cases presents challenges and leads to poorer outcomes.
• Current mechanical and pharmacological methods for coronary thrombosis removal show variable efficacy and lack clear clinical benefits.
• Significant inter-patient variability exists in response to existing thrombus management strategies.

Purpose of the Study:

• To evaluate the efficacy of intracoronary urokinase and abciximab infusion for reducing thrombus burden in PCI.
• To assess the impact of this strategy on the need for stent implantation and clinical outcomes.
• To determine the safety profile, including bleeding complications, of this combined treatment.

Main Methods:

• A cohort of 12 patients with large coronary thrombus burden undergoing urgent PCI received super-selective intracoronary infusion.
• The treatment involved urokinase (100,000 U) followed by abciximab (5 mg) administered via a microcatheter.
• Clinical outcomes and procedural success were monitored, including stent use and adverse events.

Main Results:

• A significant reduction in final thrombus area was observed post-treatment.
• Acceptable tissue perfusion was maintained, with 7 out of 12 patients avoiding stent implantation.
• No cardiovascular adverse events or bleeding complications occurred during the procedures or hospital stays.
• Uneventful 30-day clinical follow-up was reported for all patients.

Conclusions:

• Intraclot administration of urokinase followed by abciximab effectively reduced thrombotic burden.
• This reduction enabled avoidance or safer performance of stent implantation, preventing distal embolization and slow-flow.
• The treatment strategy demonstrated safety by not increasing the risk of bleeding complications.