title: Combined, superselective pharmacological management of large coronary thrombus burden.
abstract: BACKGROUND
  Percutaneous coronary intervention (PCI) in patients with a high thrombus burden is a demanding clinical situation, associated with impaired clinical outcomes. Mechanical and pharmacological management of coronary thrombosis has been shown to effectively remove a variable fraction of intracoronary thrombus. A large inter-patient variability is often observed, and large randomized trials failed to demonstrate any clear benefit of such mechanical strategies on clinical outcome.
  
  
  RESULTS
  In 12 patients undergoing urgent PCI who had a large coronary thrombus burden, we administered intracoronary, super-selective infusion of urokinase (100.000 U) followed by abciximab (5 mg) via a 2.9 Fr microcatheter. We observed a significantly reduced final thrombus area, with acceptable tissue perfusion (Table). Moreover, this strategy allowed us to abstain from stent implantation in 7/12 patients. The procedures and subsequent hospital stays were uneventful. At 30-day clinical follow up, no cardiovascular adverse events or bleeding complications were observed.
  
  
  CONCLUSIONS
  In our study, intraclot administration of urokinase followed by abciximab significantly reduced the thrombotic burden with respect to baseline. Such conspicuous reduction allowed us to abstain from stent implantation or to perform it without inducing angiographically visible distal embolization or residual slow-flow. Moreover, this treatment strategy did not increase the risk of bleeding.
authors.affiliation: Cardiovascular Department, Misericordia Hospital, Grosseto, Italy. bcortese@gmail.com
authors.forename: Bernardo
authors.initials: B
authors.lastname: Cortese
authors.forename: Andrea
authors.initials: A
authors.lastname: Micheli
authors.forename: Andrea
authors.initials: A
authors.lastname: Picchi
authors.forename: Ugo
authors.initials: U
authors.lastname: Limbruno