1/18. Successful dissolution of occlusive coronary thrombus with local administration of abciximab during PTCA.Treatment of intracoronary thrombus poses difficult problems and may result in severe complications. We used a local delivery catheter (InfusaSleeve, LocalMed, Palo Alto, CA) to treat an occlusive coronary thrombus that was refractory to systemic thrombolysis and conventional angioplasty. After local administration of 10 mg of abciximab with this catheter there was successful resolution of coronary thrombus and vessel recanalization. Cathet. Cardiovasc. Intervent. 48:211-213, 1999.- - - - - - - - - - ranking = 1keywords = administration (Clic here for more details about this article) |
2/18. Therapeutic dissolution of an intracoronary thrombus by prolonged intravenous platelet glycoprotein IIb/IIIa antagonism.This case report describes the therapeutic dissolution of an intracoronary thrombus in a patient with ectatic coronary arteries post-myocardial infarction by prolonged intravenous glycoprotein (GP) IIb/IIIa antagonist administration. The report emphasizes the potential thrombotic complications in patients with ectatic coronary arteries and the beneficial use of GP IIb/IIIa receptor antagonists as direct thrombolytic agents even in partially organized thrombus formation. In addition to the well-documented effects of GP IIb/IIIa blockade in the scenario of percutaneous interventions, unstable angina, and non-Q wave infarction, the use of this new class of drugs in acute myocardial infarction seems to be promising and might also be considered in the setting of persistent thrombotic material within the coronary vasculature.- - - - - - - - - - ranking = 0.2keywords = administration (Clic here for more details about this article) |
3/18. A case of acute myocardial infarction: intracoronary thrombus formation at a previously provoked vasospasm site.A 58-year-old Japanese man with variant angina developed acute myocardial infarction (AMI). Emergency coronary angiography demonstrated thrombotic occlusion in the proximal site of the left anterior descending artery. The occluded region appeared to be coincident with the area in which severe vasospasm had been provoked by intracoronary administration of acetylcholine 1.5 years before the onset of AMI. This case may give us a unique opportunity to consider the role of vasospasm in the etiology of AMI.- - - - - - - - - - ranking = 0.2keywords = administration (Clic here for more details about this article) |
4/18. pulse-spray thrombolysis in acute myocardial infarction caused by thrombotic occlusion of an ectatic coronary artery.pulse-spray thrombolysis was performed in 2 patients with acute myocardial infarction (AMI) caused by thrombotic occlusion of coronary artery ectasia. Case 1, a 66-year-old woman with an inferior AMI underwent emergency coronary arteriography, which revealed occlusion of an ectatic right coronary artery. Primary balloon angioplasty failed to reestablish distal flow. Urokinase was administered through the pulse-spray infusion catheter (UltraFuse) and intravenous recombinant tissue plasminogen activator was also administered. Angiographic disappearance of the thrombus was observed within 30 min of starting the infusion, and there was only mild irregularity in the ectatic coronary artery. Case 2, a 45-year-old man with an inferior AMI underwent emergency coronary arteriography, which revealed occlusion of an ectatic right coronary artery. TIMI-3 flow was soon obtained after administration of 480,000 units of urokinase through the pulse-spray infusion catheter. There was diffuse right coronary ectasia without angiographic evidence of coronary stenosis. Coronary ectasia sometimes develops into AMI without the coexistence of coronary stenosis. Because a massive thrombus plays a major role, pulse-spray thrombolysis is a possible treatment in coronary artery ectasia with thrombotic occlusion.- - - - - - - - - - ranking = 0.2keywords = administration (Clic here for more details about this article) |
5/18. Recanalization of an occluded major side branch after stenting with intracoronary adenosine.adenosine is a powerful direct coronary vasodilator with a very short half-life that has been shown to be effective in avoiding and reversing no reflow. We report an immediate successful recanalization of an occluded major side branch after stenting with acute intracoronary adenosine administration. The beneficial effect of adenosine may imply that the side branch occlusion (SBO) in this case could be due to spasm or distal embolization of the atherosclerotic debris ending up with no flow. We believe that adenosine could be helpful in at least some cases of SBO and therefore may be worth attempting.- - - - - - - - - - ranking = 0.2keywords = administration (Clic here for more details about this article) |
6/18. Power thrombectomy in acute ischemic coronary syndromes.Intracoronary thrombi are commonly found in patients with acute coronary syndromes. A large thrombus burden or a platelet-rich thrombus frequently resists pharmacologic therapy ("thrombolytic ceiling"). In such cases restoration of adequate antegrade coronary flow necessitates application of a mechanical force. Power thrombectomy is a revascularization strategy incorporating a mechanical device for removal of occlusive coronary thrombi in conjunction with or following administration of either platelet glycoprotein IIb/IIIa receptor inhibitors or thrombolytic agents, or both. Mechanical devices for power thrombectomy include ultrasound sonication, rheolytic thrombectomy (Angiojet), laser, transluminal extraction catheter, aspiration catheter, and to a limited extent, balloon angioplasty. In acute coronary syndromes the strategy of power thrombectomy aims to achieve the clinical advantages of more nearly complete vessel patency, improved antegrade flow, and enhanced preservation of myocardial tissue.- - - - - - - - - - ranking = 0.2keywords = administration (Clic here for more details about this article) |
7/18. Use of excimer laser for thrombus containing lesion.The presence of thrombus in the lesion before balloon angioplasty increases the complications arising from mechanical intervention. It is known that the use of Gp llb/llla receptor blockers before the intervention enhances the reliability of the procedure. Laser thrombolysis was applied to a patient who underwent coronary angiography due to recurrent chest pain after thirty six hour administration of tirofiban and who was found to have a thrombus so large as to block the distal vessel bed of the right coronary artery. Following the procedure, the entire thrombus was broken down and Grade III distal myocardial perfusion was achieved. This case is important in demonstrating that laser application is a viable alternative in such instances, especially considering that intervention in acute coronary syndromes is on the increase and cardiologists will frequently encounter such cases.- - - - - - - - - - ranking = 0.2keywords = administration (Clic here for more details about this article) |
8/18. Successful recanalization of an occluded coronary artery by percutaneous coronary intervention, systemic administration of tirofiban, a glycoprotein IIb/IIIa inhibitor, and intracoronary thrombolysis with alteplase.A 51 year-old male was admitted to our institution with subacute inferior myocardial infarction. coronary angiography showed thrombotic occlusion of the right coronary artery. percutaneous coronary intervention including the delivery of 3 stents was unsuccessful (TIMI grade 0 flow). In addition to an ongoing systemic administration of tirofiban, a glycoprotein IIb/IIIa inhibitor, the patient received intracoronary thrombolysis (ICT) with alteplase (recombinant tissue type plasminogen activator, rt-PA). There was complete reperfusion on control angiography the following day (TIMI grade 3 flow); 7 months later, there was still TIMI grade 3 flow. To our knowledge, this is the first report on systemic administration of tirofiban combined with ICT.- - - - - - - - - - ranking = 1.2keywords = administration (Clic here for more details about this article) |
9/18. Spontaneous pulmonary hemorrhage following coronary thrombolysis.Excessive bleeding is a major concern during the administration of thrombolytic therapy. Although the great majority of these events occur at sites of vascular interruption, major gastrointestinal, retroperitoneal, genitourinary, and central nervous system hemorrhage are known to occur. We present a patient who developed spontaneous pulmonary hemorrhage during thrombolytic therapy. Lack of recognition that the lungs too may be a site of spontaneous hemorrhage during thrombolytic therapy may lead to a considerable diagnostic and therapeutic delay. Pulmonary hemorrhage should be considered in the differential diagnosis of patients who receive thrombolytic therapy in whom new roentgenographic pulmonary infiltrates present accompanied by decreases in hematocrit value.- - - - - - - - - - ranking = 0.2keywords = administration (Clic here for more details about this article) |
10/18. Combination of a high bolus dose of tirofiban with half-dose thrombolytics for the treatment of subacute stent thrombosis.Acute stent thrombosis is rare and it is usually related to complications during the procedure. Subacute thrombosis is far more common and is associated with a high incidence of acute myocardial infarction and death. Restoration of flow by thrombolysis, emergency bypass surgery or emergency percutaneous transluminal coronary angioplasty (PTCA) has had only limited success with respect to myocardial salvage. We report the case of a patient who suffered from recurrent subacute stent thrombosis, in whom administration of tirofiban at high-dose bolus in association with a half dose of recombinant tissue plasminogen activator succeeded in restoring normal myocardial flow and stable clinical condition.- - - - - - - - - - ranking = 0.2keywords = administration (Clic here for more details about this article) |
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