Methodologic aspects of intracoronary thrombolysis. Drugs, dosage and duration

Clinical experience indicates that the methods of intracoronary thrombolysis are not standardized. Although overall reperfusion rates of 75-80% have been achieved, clinical application at individual centers reflects variations in thrombolytic agents used, dosage, infusion rates, technique of administration and use of adjunctive measures, as well as variation in rates of successful recanalization. Analysis of results as a function of differences in approach suggests that certain procedural factors may influence reperfusion rates. Within the range of total dosage and infusion rates used, higher dosage levels and infusion rates appear to be associated with higher rates of reperfusion. Experimental and preliminary clinical results also suggest that subselective infusion may be associated with higher response rates than ostial infusion of thrombolytic agents. However, additional studies are needed to define the optimal methods of intracoronary thrombolytic therapy.