Coronary arteries occluded by long lengths of thrombus are usually considered unattractive for angioplasty. Nine patients (8 male, mean age 50.1 years) undergoing angiography for unstable angina were found to have single vessel disease considered unsuitable for angioplasty as the vessel was occluded by a long length of thrombus. These patients were treated with 24 hr intracoronary infusions of 100 mg tPA in an attempt to make angioplasty feasible. Marked thrombolysis occurred in 7 patients who received uncomplicated infusions. One case was unsuccessful due to catheter displacement, while another had the infusion ceased due to an intracerebral bleed from a previously silent A-V malformation. This was the only major complication. Angioplasty was attempted in 6 of 7 cases where lysis had been achieved, with success in all lesions attempted. This reports shows that intracoronary tPA infused over prolonged periods produces excellent thrombolysis, making angioplasty feasible in some patients who were previously unsuitable.

Angina, Unstable↗

PubMed1991

A solution to the problem of an unexpanded Palmaz-Schatz stent following balloon rupture.

The Palmaz-Schatz stent is a balloon expandable stent. Although easy to deploy, problems can occur. One problem is balloon rupture resulting in a partially expanded stent, which can be difficult to expand fully. This report illustrates how a Probing catheter and balloon can solve this potentially serious problem.

Aged↗

PubMed1984

A comparison of intravenous and intracoronary streptokinase in acute myocardial infarction.

A randomised study of intravenous and intracoronary streptokinase therapy was carried out in 20 subjects with acute myocardial infarction and angiographically confirmed complete obstruction of the associated coronary artery. Two dose levels of therapy were used. Although more recanalisations occurred with intracoronary than intravenous therapy at the low dose levels, overall there was not a significant difference between the two groups; one million IU intravenously over 20 minutes recanalised four of five arteries. While seven of nine recanalisations with intracoronary therapy occurred within an hour, only two of five with intravenous therapy did so. Hence prolonged angiographic observation is necessary to document recanalisation with intravenous therapy adequately. Nevertheless, the time disadvantage of large dose intravenous therapy is not great and it may yet prove as effective as, and more practical than, intracoronary therapy.

Female↗