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Staged thrombolysis and percutaneous transluminal coronary angioplasty for unstable and postinfarction angina
D V Hurley1, D R Bresnahan, D R Holmes
1Mayo Clinic, Rochester, MN 55905.
Insights
Staged thrombolysis followed by deferred angioplasty is a viable treatment for acute coronary syndromes. This approach helps reduce the risk of acute occlusion during coronary angioplasty in patients with unstable angina.
Area of Science:
- Cardiology
- Interventional Cardiology
- Acute Coronary Syndromes
Background:
- Coronary angioplasty is effective for unstable angina and postinfarction angina but carries a significant risk of thromboembolic coronary occlusion (24-29%).
- The optimal timing for interventions like intravenous thrombolysis and coronary angioplasty in patients with coronary thrombosis remains under investigation.
Observation:
- Three patients with intracoronary thrombus and acute coronary syndromes (unstable angina or postinfarction angina) were treated with a staged approach.
- This approach involved initial intravenous thrombolysis and oral antiplatelet therapy, followed by deferred coronary angioplasty.
Findings:
- The staged thrombolysis and deferred angioplasty strategy was successful in all three observed patients.
- Adjunctive thrombolysis and antiplatelet therapy improved the success rate of angioplasty and decreased the risk of acute occlusion.
Implications:
- Staged thrombolysis and deferred angioplasty is a feasible and effective strategy for selected patients presenting with acute coronary syndromes and intracoronary thrombus.
- This approach offers a potential alternative to immediate angioplasty, mitigating risks associated with thromboembolic events.
Abstract:
The precise timing of intravenous thrombolysis and coronary angioplasty continues to be evaluated for patients who have coronary thrombosis and unstable angina or postinfarction angina. Coronary angioplasty is effective for these patients but is associated with thromboembolic coronary occlusion in 24% to 29% of cases. After adjunctive intravenous thrombolysis and oral antiplatelet therapy to improve the success rate and to decrease the risk of acute occlusion, deferred angioplasty was successful in three patients with intracoronary thrombus and unstable angina or postinfarction angina. Staged thrombolysis and deferred angioplasty is feasible for selected patients with these acute coronary syndromes.