title: Coronary artery stenting with high-pressure post-dilation followed by adjunctive thrombolysis after failed coronary angioplasty for acute myocardial infarction: report of three cases.
abstract: We successfully implanted coronary stents into refractory reoccluded lesions after failed coronary angioplasty in three patients with acute myocardial infarction (AMI). Lesion location was the proximal left anterior descending coronary artery in two patients and the dominant right coronary artery in one patient. The reference diameters of the lesions were 3.64, 3.33, and 3.50 mm, respectively. A stent with a luminal diameter of 3.0 mm was implanted in all patients. Poststenting dilation of the stent was performed at high pressure (18 atm), and urokinase was administered immediately thereafter. Heparin was administered for 24 h with maintenance of activated coagulation time within 180-200 s. Warfarin was then administered to keep the international normalized ratio within 2.5-3.5. Luminal diameters immediately after stenting were 3.14, 2.89, and 3.26 mm, and those at 1 month after stenting were 3.09, 2.81, and 3.12 mm, respectively, indicating good patency. Our experience in these cases suggests that coronary stenting can be applied after unsuccessful coronary angioplasty in selected patients with AMI. The present report includes informative reference data on diameter, postdilation, adjunctive thrombolytic agent administration, and adequate anticoagulation therapy in coronary stenting in this acute application.
authors.affiliation: Cardiovascular Center, Sakakibara Hospital, Okayama, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Iwasaki
authors.forename: S
authors.initials: S
authors.lastname: Yamasaki
authors.forename: S
authors.initials: S
authors.lastname: Kusachi
authors.forename: K
authors.initials: K
authors.lastname: Takeuchi
authors.forename: S
authors.initials: S
authors.lastname: Matano
authors.forename: T
authors.initials: T
authors.lastname: Kita
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D000925:Anticoagulants / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003327:Coronary Disease / Q000628:therapy*; D005260:Female; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy*; D010960:Plasminogen Activators / Q000627:therapeutic use*; D012008:Recurrence; D015607:Stents; D015912:Thrombolytic Therapy; D017211:Treatment Failure; D014568:Urokinase-Type Plasminogen Activator / Q000627:therapeutic use*; D014859:Warfarin / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D014859:Warfarin; D006493:Heparin; D010960:Plasminogen Activators; D014568:Urokinase-Type Plasminogen Activator