Percutaneous transluminal coronary artery recanalization in evolving myocardial infarction

A brief description of recanalization of the thrombotic coronary artery is provided, including the historical background and our own first experience of recanalization during the event of an acute catheter complication. Mechanical recanalization of occluded coronary arteries as initially performed by us is described. The subsequent use of intracoronary infusion of streptokinase is also detailed. An account is given of the angiographic and clinical results in a study of 59 patients. We then consider the encountered and potential complications of percutaneous transluminal coronary artery recanalization (PTCR) based on a study of 232 acute infarction patients treated in four different centers. A discussion of the potential benefits of the intervention is provided, including lower mortality in a patient subgroup that underwent successful recanalization, as well as improved left ventricular function as seen angiographically in successfully recanalized patients. Use of intracoronary thallium injections before and after recanalization is discussed. It is stated that precise delineation of efforts will require randomized control trials. Finally, we provide some suggestions as to the potential follow-up treatment and future development of the technique.