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[The course of residual stenosis after intracoronary thrombolysis]
V Franceschino1, G M Contini, P Terrosu
1Divisione di Cardiologia, Ospedale Regionale, Sassari.
Insights
Residual coronary stenosis after acute myocardial infarction thrombolysis can significantly improve over one year. This natural improvement suggests a dynamic process that should inform decisions about further interventions like coronary surgery or percutaneous transluminal coronary angioplasty.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Biology
Context:
- Clinical outcomes after coronary thrombolysis depend on residual stenosis.
- The natural history of residual coronary stenosis is not well understood.
- Assessing residual stenosis requires serial angiographic evaluation.
Purpose:
- To evaluate the natural history of residual coronary stenosis after urokinase-induced recanalization in acute myocardial infarction.
- To analyze changes in vessel contours, luminal diameter reduction, and intraluminal filling defects over time.
Summary:
- Serial coronary angiograms were analyzed in 25 patients one year post-thrombolysis.
- Residual stenosis significantly improved from 92% +/- 7% acutely to 76% +/- 11% at one year.
- Early "complicated" stenosis with irregular contours and thrombus resolved into smooth, "uncomplicated" lesions.
Impact:
- Residual coronary stenosis is a dynamic process that can improve, not a static endpoint.
- Understanding this dynamic nature is essential for appropriate management decisions, including surgical intervention or percutaneous transluminal coronary angioplasty (PTCA).
Unlabelled:
Clinical outcome after coronary thrombolysis are strictly related to the residual stenosis. However, the natural history of this lesion is largely unknown. To assess this topic we evaluated 25 patients who had coronary recanalization by urokinase in acute myocardial infarction. Serial coronary angiograms were taken immediately after fibrinolytic therapy, before hospital discharge and 1 year later. Angiographically detected coronary reocclusion and/or new ischemic events were exclusion criteria. Angiographic analysis was performed at a five-fold magnification. The followings were specifically evaluated: a) vessel contours at the site of the residual stenosis; b) luminal diameter reduction; c) presence of intraluminal filling defects.
Results:
the vessel narrowing progressively improved from the acute phase (percent of stenosis 92 +/- 7) to the hospital discharge (82 +/- 8%, p less than .01) and to 1 year follow-up (76 +/- 11%, p less than .001 vs hospital discharge). Moreover, the residual stenosis appears to be "complicated" in early period (irregular contours with superimposed thrombus), but become regular and "uncomplicated" at follow-up examination (smooth contours, hourglass configuration, no intraluminal filling defects).
In Conclusion:
a) the residual coronary stenosis is a dynamic process and may improve at follow-up examination; b) a practical approach to the management of the residual stenosis must take in account the natural history of the lesion to give a correct indication for coronary surgery or PTCA.