title: Intracoronary thrombolysis in patients with ST-segment elevation myocardial infarction presenting with massive intraluminal thrombus and failed aspiration.
abstract: OBJECTIVE
  Massive intracoronary thrombus is associated with adverse procedural results including failed aspiration and unfavourable reperfusion. In this scenario the best treatment remains unknown. We aim to evaluate the effect of low dose intracoronary thrombolysis in patients with ST-segment elevation myocardial infarction (STEMI) presenting with a large thrombus burden and failed aspiration.
  
  
  RESULTS
  In this study 30 STEMI patients with a large thrombus burden and failed manual aspiration were included in the registry. Local fibrinolysis with low dose (one-third of systemic) tenecteplase (27%) or alteplase (73%) was administered via a 6F-infusion catheter. A thrombus was qualified as large when its maximal dimension was ≥2 vessels (thrombolysis in myocardial infarction (TIMI) thrombus grade 4 and 5). Altogether 33% of patients received delayed invasive therapy (>12 h) guided by the presence of recurrent symptoms and/or ischaemia. A total of 17% of patients presented with cardiogenic shock and half of the population received glycoprotein IIb/IIIa inhibitors. A post-lysis thrombus grade 4-5 was found in just one patient. TIMI flow grade improved from 0/1 at baseline (93%) to ≥2 in most patients (97%). Blush grade 2-3 was observed in 85% and we observed a similar percentage (82%) of more than 50% ST-segment resolution. In-hospital mortality was 10% (three patients with cardiogenic shock). No major bleeding events were observed. At a median follow-up of 14 (6-35) months, only one new clinical event was reported (1 target lesion revascularization, (TLR)).
  
  
  CONCLUSIONS
  In STEMI patients with a large thrombus burden and failed manual aspiration, administration of low dose intracoronary thrombolysis is safe and reduces trhombus burden, as a result improving in epicardial flow and myocardial reperfusion.
authors.affiliation: Department of Cardiology, Hospital de la Santa Creu y Sant Pau, Barcelona, Spain.
authors.forename: Daniela
authors.initials: D
authors.lastname: Boscarelli
authors.affiliation: Department of Cardiology, Hospital de la Santa Creu y Sant Pau, Barcelona, Spain beavaquerizo@yahoo.es.
authors.forename: Beatriz
authors.initials: B
authors.lastname: Vaquerizo
authors.affiliation: Department of Cardiology, Hospital Parc de salut Mar, Barcelona, Spain.
authors.forename: Faustin
authors.initials: F
authors.lastname: Miranda-Guardiola
authors.affiliation: Department of Cardiology, Hospital de la Santa Creu y Sant Pau, Barcelona, Spain.
authors.forename: Dabit
authors.initials: D
authors.lastname: Arzamendi
authors.affiliation: Department of Cardiology, Hospital Parc de salut Mar, Barcelona, Spain.
authors.forename: Helena
authors.initials: H
authors.lastname: Tizon
authors.affiliation: Department of Cardiology, Hospital Parc de salut Mar, Barcelona, Spain.
authors.forename: Gilberto
authors.initials: G
authors.lastname: Sierra
authors.affiliation: Department of Cardiology, Hospital de la Santa Creu y Sant Pau, Barcelona, Spain.
authors.forename: Guillermo
authors.initials: G
authors.lastname: Delgado
authors.affiliation: Department of Cardiology, Hospital Parc de salut Mar, Barcelona, Spain.
authors.forename: Andres
authors.initials: A
authors.lastname: Fantuzzi
authors.affiliation: Department of Cardiology, Hospital de la Santa Creu y Sant Pau, Barcelona, Spain.
authors.forename: Darlene
authors.initials: D
authors.lastname: Estrada
authors.affiliation: Department of Cardiology, Hospital de la Santa Creu y Sant Pau, Barcelona, Spain.
authors.forename: Joan
authors.initials: J
authors.lastname: Garcia-Picart
authors.affiliation: Department of Cardiology, Hospital de la Santa Creu y Sant Pau, Barcelona, Spain.
authors.forename: Juan
authors.initials: J
authors.lastname: Cinca
authors.affiliation: Department of Cardiology, Hospital de la Santa Creu y Sant Pau, Barcelona, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Serra
mesh_terms: D006328:Cardiac Catheterization / Q000295:instrumentation / Q000379:methods; D017023:Coronary Angiography; D003328:Coronary Thrombosis / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000601:surgery; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D017052:Hospital Mortality; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000601:surgery; D015425:Myocardial Reperfusion / Q000379:methods; D000077785:Tenecteplase; D017131:Thrombectomy / Q000295:instrumentation / Q000379:methods; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator; D000077785:Tenecteplase
keywords: Intracoronary thrombolysis; massive thrombosis; thromboaspiration