Intracoronary Artery Retrograde Thrombolysis for ST-segment Elevation Myocardial Infarction with a Tortuous Coronary Artery: A Case Report and Review of the Literature

Overview

Journal Front Cardiovasc Med

Specialty Cardiology & Vascular Diseases

Date 2022 Aug 22

PMID 35990969

Authors

Mingzhi Shen

Haihui Lu

Yichao Liao

Jian Wang

Yi Guo

Xinger Zhou

Yingqiao Nong

Zhenhong Fu

Jihang Wang

Yuting Guo

Shihao Zhao

Li Fan

Jinwen Tian

Affiliations

Soon will be listed here.

Abstract

Background: How to deal with large thrombus burdens of culprit's blood vessel remains a great challenge in the treatment of acute myocardial infarction.

Case Presentation: A 32-year-old Chinese man was diagnosed with ST-segment elevation myocardial infarction (STEMI). Coronary angiography revealed that the distal end of a tortuous left circumflex was completely occluded by a large amount of thrombus. Cutted balloon-directed intracoronary artery retrograde thrombolysis (ICART) with urokinase led to the restoration of coronary blood flow. Because there was no obvious plaque rupture or artery stenosis in the coronary artery, it was only dilated, and no stent was implanted.

Conclusion: Cutted balloon-directed ICART can be performed effectively and safely in some STEMI patients with tortuous coronary vessels and large thrombus. (REST or named ICART ClinicalTrials.gov number, ChiCTR1900023849).

References

Tian J, Zhu M, Wang F, Li K, Zhou C, Li B . Intracoronary arterial retrograde thrombolysis with percutaneous coronary intervention: a novel use of thrombolytic to treat acute ST-segment elevation myocardial infarction. J Geriatr Cardiol. 2019; 16(6):458-467. PMC: 6612613. DOI: 10.11909/j.issn.1671-5411.2019.06.004. View

Antman E . Time is muscle: translation into practice. J Am Coll Cardiol. 2008; 52(15):1216-21. DOI: 10.1016/j.jacc.2008.07.011. View

Ndrepepa G, Tiroch K, Fusaro M, Keta D, Seyfarth M, Byrne R . 5-year prognostic value of no-reflow phenomenon after percutaneous coronary intervention in patients with acute myocardial infarction. J Am Coll Cardiol. 2010; 55(21):2383-9. DOI: 10.1016/j.jacc.2009.12.054. View

Antman E, Hand M, Armstrong P, Bates E, Green L, Halasyamani L . 2007 Focused Update of the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines: developed in.... Circulation. 2007; 117(2):296-329. DOI: 10.1161/CIRCULATIONAHA.107.188209. View

Lee Y, Kim E, Kim B, Shin J . A case of successful reperfusion through a combination of intracoronary thrombolysis and aspiration thrombectomy in ST-segment elevation myocardial infarction associated with an ectatic coronary artery. BMC Cardiovasc Disord. 2017; 17(1):94. PMC: 5382492. DOI: 10.1186/s12872-017-0527-0. View

Gibson C, de Lemos J, Antman E . Time is muscle in primary PCI: the strength of the evidence grows. Eur Heart J. 2004; 25(12):1001-2. DOI: 10.1016/j.ehj.2004.04.029. View

Jaffe R, Dick A, Strauss B . Prevention and treatment of microvascular obstruction-related myocardial injury and coronary no-reflow following percutaneous coronary intervention: a systematic approach. JACC Cardiovasc Interv. 2010; 3(7):695-704. DOI: 10.1016/j.jcin.2010.05.004. View

Lagerqvist B, Frobert O, Olivecrona G, Gudnason T, Maeng M, Alstrom P . Outcomes 1 year after thrombus aspiration for myocardial infarction. N Engl J Med. 2014; 371(12):1111-20. DOI: 10.1056/NEJMoa1405707. View

Vlaar P, Svilaas T, Van Der Horst I, Diercks G, Fokkema M, de Smet B . Cardiac death and reinfarction after 1 year in the Thrombus Aspiration during Percutaneous coronary intervention in Acute myocardial infarction Study (TAPAS): a 1-year follow-up study. Lancet. 2008; 371(9628):1915-20. DOI: 10.1016/S0140-6736(08)60833-8. View

10.

Thiele H, Schindler K, Friedenberger J, Eitel I, Furnau G, Grebe E . Intracoronary compared with intravenous bolus abciximab application in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention: the randomized Leipzig immediate percutaneous coronary intervention.... Circulation. 2008; 118(1):49-57. DOI: 10.1161/CIRCULATIONAHA.107.747642. View

11.

Munoz D, Roettig M, Monk L, Al-Khalidi H, Jollis J, Granger C . Transport time and care processes for patients transferred with ST-segment-elevation myocardial infarction: the reperfusion in acute myocardial infarction in Carolina emergency rooms experience. Circ Cardiovasc Interv. 2012; 5(4):555-62. PMC: 3600977. DOI: 10.1161/CIRCINTERVENTIONS.112.968461. View

12.

Widimsky P, Wijns W, Fajadet J, de Belder M, Knot J, Aaberge L . Reperfusion therapy for ST elevation acute myocardial infarction in Europe: description of the current situation in 30 countries. Eur Heart J. 2009; 31(8):943-57. PMC: 2854523. DOI: 10.1093/eurheartj/ehp492. View

13.

Jolly S, Cairns J, Yusuf S, Meeks B, Pogue J, Rokoss M . Randomized trial of primary PCI with or without routine manual thrombectomy. N Engl J Med. 2015; 372(15):1389-98. PMC: 4995102. DOI: 10.1056/NEJMoa1415098. View

14.

Frobert O, Lagerqvist B, Gudnason T, Thuesen L, Svensson R, Olivecrona G . Thrombus Aspiration in ST-Elevation myocardial infarction in Scandinavia (TASTE trial). A multicenter, prospective, randomized, controlled clinical registry trial based on the Swedish angiography and angioplasty registry (SCAAR) platform. Study.... Am Heart J. 2010; 160(6):1042-8. DOI: 10.1016/j.ahj.2010.08.040. View

15.

Eitel I, Wohrle J, Suenkel H, Meissner J, Kerber S, Lauer B . Intracoronary compared with intravenous bolus abciximab application during primary percutaneous coronary intervention in ST-segment elevation myocardial infarction: cardiac magnetic resonance substudy of the AIDA STEMI trial. J Am Coll Cardiol. 2013; 61(13):1447-54. DOI: 10.1016/j.jacc.2013.01.048. View

16.

Limbruno U, De Caterina R . EMERALD, AIMI, and PROMISE: is there still a potential for embolic protection in primary PCI?. Eur Heart J. 2006; 27(10):1139-45. DOI: 10.1093/eurheartj/ehi755. View

17.

Napodano M, Dariol G, Al Mamary A, Perazzolo Marra M, Tarantini G, DAmico G . Thrombus burden and myocardial damage during primary percutaneous coronary intervention. Am J Cardiol. 2014; 113(9):1449-56. DOI: 10.1016/j.amjcard.2014.01.423. View

18.

Kushner F, Hand M, Smith Jr S, King 3rd S, Anderson J, Antman E . 2009 focused updates: ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction (updating the 2004 guideline and 2007 focused update) and ACC/AHA/SCAI guidelines on percutaneous coronary intervention (updating the.... J Am Coll Cardiol. 2009; 54(23):2205-41. DOI: 10.1016/j.jacc.2009.10.015. View