Use of local drug delivery for treating intracoronary thrombus and thrombus-containing stenoses.
The local delivery of thrombolytic agents directly to the site of intracoronary thrombus using catheter-based technology is a new technique for treating intraluminal clot and thrombus-containing stenoses that is currently under active investigation. The theoretic mechanism of thrombolysis underlying this approach involves the 'trapping' of thrombus in an environment of high thrombolytic drug concentration, mechanical disruption of intraluminal clot by the drug delivery catheter itself, and intramural deposition of lytic agents with the creation of a drug reservoir that may provide for prolonged local thrombolysis. To date, animal studies with five local drug delivery catheters have documented successful intramural deposition of thrombolytic agents at balloon angioplasty sites. Three of these devices have also been successfully used in patients to treat intracoronary thrombus, with preliminary results suggesting that thrombolysis can be achieved using much lower doses of lytic agents than are employed in standard infusion protocols and with low complication rates. These preliminary observations will be studied further in two multicentre randomized protocols comparing local thrombolysis with standard techniques for treating intracoronary thrombus.
McKay
R G
RG
Department of Internal Medicine, Hartford Hospital, University of Connecticut 06115, USA.
D000818:Animals; D001672:Biocompatible Materials; D002404:Catheterization / Q000295:instrumentation; D003328:Coronary Thrombosis / Q000188:drug therapy*; D016503:Drug Delivery Systems; D005343:Fibrinolytic Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D006801:Humans; D020136:Hydrogel, Polyethylene Glycol Dimethacrylate; D007261:Infusions, Intra-Arterial / Q000379:methods*; D010969:Plastics; D011090:Polyenes; D011092:Polyethylene Glycols; D015912:Thrombolytic Therapy
D001672:Biocompatible Materials; D005343:Fibrinolytic Agents; D010969:Plastics; D011090:Polyenes; D020136:Hydrogel, Polyethylene Glycol Dimethacrylate; D011092:Polyethylene Glycols; C035051:PL 732