Intracoronary prourokinase for coronary embolism after aortic valve replacement: a viable treatment option?

BACKGROUND: Coronary embolism (CE) is a rare but life-threatening cause of acute myocardial infarction (AMI) in patients following mechanical aortic valve replacement (AVR), often resulting from subtherapeutic anticoagulation. Due to the absence of consensus management guidelines, treatment strategies remain individualized. CASE PRESENTATION: A 67-year-old man with a history of mechanical AVR presented with inferior ST-segment elevation myocardial infarction after discontinuing warfarin for one week, resulting in subtherapeutic anticoagulation. Emergency coronary angiography revealed abrupt occlusion of the mid-right coronary artery (RCA) without underlying atherosclerosis. Targeted intracoronary administration of 20 mg recombinant human prourokinase (rh-proUK) via a microcatheter enabled effective thrombus aspiration and complete restoration of TIMI 3 flow without residual stenosis, thereby avoiding stent implantation. CONCLUSION: This case demonstrates that intracoronary rh-proUK administration serves as an effective rescue therapy for refractory CE when conventional interventions fail, enabling stent-free revascularization. The findings also underscore the importance of strict lifelong anticoagulation in patients with mechanical valves.