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Percutaneous transluminal coronary angioplasty in the setting of large intracoronary thrombi
M R Mooney1, J F Mooney, I F Goldenberg
1Minneapolis Heart Institute, Abbott Northwestern Hospital, Minnesota 55407.
Insights
Percutaneous transluminal coronary angioplasty effectively treats patients with intracoronary thrombi, achieving high initial success and excellent long-term outcomes without thrombolytic therapy.
Area of Science:
- Cardiology
- Interventional Cardiology
Background:
- Intracoronary thrombus presents a significant challenge in acute coronary syndromes.
- Optimal management strategies for patients with intracoronary thrombi undergoing percutaneous coronary intervention (PCI) are crucial.
Purpose of the Study:
- To evaluate the early and late clinical outcomes of PCI in patients with angiographically defined intracoronary thrombi.
- To assess the efficacy and safety of a specific PCI protocol involving intracoronary heparin and prolonged balloon inflations.
Main Methods:
- A prospective cohort study included 112 consecutive patients with intracoronary thrombi.
- Treatment involved PCI with intravenous and intracoronary heparin, antiplatelet agents, and prolonged inflations using oversized balloons (1.2:1 ratio).
- No periprocedural thrombolytic therapy or routine prolonged heparin pretreatment was administered.
Main Results:
- Initial clinical success was achieved in 92% of patients (103/112) at hospital discharge.
- In-hospital complications included 3.5% requiring elective coronary bypass surgery and 3.5% needing emergency coronary artery bypass grafting due to abrupt closure.
- At a mean 7-month follow-up, 95% of patients were event-free (no coronary artery bypass surgery, myocardial infarction, or death), with 73% remaining asymptomatic.
Conclusions:
- Coronary angioplasty alone, utilizing intracoronary heparin and prolonged balloon inflations with oversized balloons, can yield high initial success rates.
- This approach demonstrates a low incidence of in-hospital complications and excellent long-term results in patients with intracoronary thrombus.
- The findings suggest PCI is a viable primary treatment for intracoronary thrombus, potentially avoiding thrombolytic agents.
Abstract:
A cohort of 112 consecutive patients with angiographically defined intracoronary thrombi was treated with percutaneous transluminal coronary angioplasty and followed prospectively to determine early and late outcomes. Coronary angioplasty using a treatment modality of intravenous and intracoronary heparin, antiplatelet agents and prolonged inflations with oversized balloons (balloon:vessel ratio, 1.2:1) resulted in clinical success in 103 patients (92%) at hospital discharge. No periprocedural thrombolytic therapy was used and prolonged pretreatment with heparin was not routinely used. Four patients (3.5%) required elective coronary bypass surgery, and 4 patients (3.5%) required emergency coronary artery bypass grafting because of abrupt closure. Late clinical follow-up (mean 7 months) was available in 99 of the 103 successfully treated patients (96%). Seventy-three percent of patients were asymptomatic at follow-up, and 27% had class I or II angina. No patients had a late myocardial infarction. Elective coronary artery bypass surgery was required in 3 patients (3%) and repeat coronary angioplasty in 17 patients (17%). There were 2 late cardiac deaths at 7 months. Ninety-four patients (95%) had an event free follow-up defined as absence of coronary artery bypass surgery, myocardial infarction or death. In conclusion, coronary angioplasty alone, using intracoronary heparin and prolonged balloon inflations with relatively oversized balloons may be helpful to achieve a high initial success rate, low incidence of in-hospital complications and excellent long-term results in patients with intracoronary thrombus.