title: Intracoronary thrombolytic therapy: a treatment option for failed mechanical thrombectomy.
abstract: The benefit of the routine application of aspiration thrombectomy in primary percutaneous coronary intervention (PPCI) is now well established. The optimal management of patients who have "failed" thrombectomy characterized by a large residual thrombus burden after repeated mechanical thrombectomy, however, is not known. We report a case of failed aspiration thrombectomy in a 66-year-old woman who was admitted to our institution with chest pain associated with inferior ST segment elevation. Coronary angiography showed a thrombotic occlusion of the right coronary artery. Aspiration thrombectomy did little to reduce thrombus load and so the patient was treated with intracoronary tenecteplase. Repeat coronary angiography 18 hr later revealed marked thrombus resolution with thrombolysis in myocardial infarction (TIMI) grade 3 anterograde flow and patency of the infarct-related artery was maintained at 2-month follow up. This case demonstrates the potential for intracoronary thrombolytic therapy as a treatment option for the management of patients following failed thrombectomy in PPCI.
authors: Department of Cardiology, London Chest Hospital, London, United Kingdom.
authors: Sean
authors: S
authors: Gallagher
authors: Ajay K
authors: AK
authors: Jain
authors: R Andrew
authors: RA
authors: Archbold
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D003328:Coronary Thrombosis / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D006801:Humans; D056989:Inferior Wall Myocardial Infarction / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D007269:Injections, Intra-Arterial; D013396:Suction; D000077785:Tenecteplase; D017131:Thrombectomy / Q000379:methods*; D015912:Thrombolytic Therapy; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*; D017211:Treatment Failure; D014654:Vascular Patency
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator; D000077785:Tenecteplase