Site-specific, catheter-based thrombolysis: a new technique for treating intracoronary thrombus and thrombus-containing stenosis.
Site-specific thrombolysis is a new technique for treating intracoronary thrombus and thrombus-containing stenoses that is currently under active investigation and that involves the local delivery of thrombolytic agents directly to intraluminal clot using catheter-based technology. The theoretic mechanisms 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, preliminary studies have documented enhanced local thrombolysis with urokinase using two new drug delivery systems--the Dispatch catheter and the hydrogel-coated balloon. In 68 patients that have been reported to date, use of these two new systems has resulted in enhanced intracoronary thrombolysis using much less urokinase than involved in standard infusion protocols, and with low complication rates. These preliminary observations will be further studied in two multicenter randomized protocols comparing local drug delivery with standard techniques for treating intracoronary thrombus.
McKay
R G
RG
Department of Internal Medicine, Hartford Hospital, University of Connecticut 06115, USA.
D015906:Angioplasty, Balloon, Coronary / Q000295:instrumentation*; D003328:Coronary Thrombosis / Q000188:drug therapy*; D016503:Drug Delivery Systems; D006801:Humans; D006859:Hydrogen; D015337:Multicenter Studies as Topic; D016032:Randomized Controlled Trials as Topic; D015912:Thrombolytic Therapy / Q000295:instrumentation*; D016896:Treatment Outcome; D014568:Urokinase-Type Plasminogen Activator / Q000008:administration & dosage* / Q000009:adverse effects