title: Thrombolysis-facilitated primary percutaneous coronary intervention as a therapeutic approach to stent thrombosis.
abstract: BACKGROUND
  Stent thrombosis is a clinically significant event occurring days to weeks or, infrequently, months or years after percutaneous coronary intervention (PCI). Current therapeutic approach is immediate PCI aimed to recanalize the occluded artery in order to restore flow and diminish irreversible myocardial damage.
  
  
  METHODS
  We evaluated the coronary patency, TIMI flow and TIMI myocardial perfusion grade (TMPG) in 6 patients presenting with STEMI due to stent thrombosis treated by thrombolysis followed by immediate PCI. These were compared with control patients treated conventionally by primary PCI.
  
  
  RESULTS
  Immediate or early coronary angiography in the treatment group showed good coronary flow in 5 of 6 implicated arteries, whereas immediate angiography in the control group demonstrated 8 completely occluded coronary arteries of 9 with stent thrombosis. The pre-intervention TIMI flow in the control study group was 0.2±0.5 (median-0), and TMPG was 0.1±0.3 (median-0) compared with 2.1±1.1 (median-2.3, p<0.001) and 1.8±1.0 (median-2, p<0.001) in the treatment group, respectively. This striking difference in the rate of coronary patency, pre-procedural TIMI flow and TMPG, however, did not translate into better cardiac function in the treatment group.
  
  
  CONCLUSIONS
  These findings suggest that thrombolysis-facilitated PCI may confer benefit and need not be considered contraindicated when treating stent thrombosis. This therapeutic approach should be evaluated as a viable therapeutic approach to stent thrombosis.
authors.affiliation: Heart Institute, Hillel Yaffe Medical Center, Hadera, affiliated to the Rappaport Medical School, The Technion- Israel Institute of Technology, Haifa, Israel. Electronic address: meisel@hy.health.gov.il.
authors.forename: Simcha R
authors.initials: SR
authors.lastname: Meisel
authors.affiliation: Heart Institute, Hillel Yaffe Medical Center, Hadera, affiliated to the Rappaport Medical School, The Technion- Israel Institute of Technology, Haifa, Israel.
authors.forename: Michael
authors.initials: M
authors.lastname: Shochat
authors.affiliation: Heart Institute, Hillel Yaffe Medical Center, Hadera, affiliated to the Rappaport Medical School, The Technion- Israel Institute of Technology, Haifa, Israel.
authors.forename: Aaron
authors.initials: A
authors.lastname: Frimerman
authors.affiliation: Heart Institute, Hillel Yaffe Medical Center, Hadera, affiliated to the Rappaport Medical School, The Technion- Israel Institute of Technology, Haifa, Israel.
authors.forename: Yaniv
authors.initials: Y
authors.lastname: Levi
authors.affiliation: Heart Institute, Hillel Yaffe Medical Center, Hadera, affiliated to the Rappaport Medical School, The Technion- Israel Institute of Technology, Haifa, Israel.
authors.forename: David S
authors.initials: DS
authors.lastname: Blondheim
authors.affiliation: Heart Institute, Hillel Yaffe Medical Center, Hadera, affiliated to the Rappaport Medical School, The Technion- Israel Institute of Technology, Haifa, Israel.
authors.forename: Mark
authors.initials: M
authors.lastname: Kazatsker
authors.affiliation: Heart Institute, Hillel Yaffe Medical Center, Hadera, affiliated to the Rappaport Medical School, The Technion- Israel Institute of Technology, Haifa, Israel.
authors.forename: Lubov
authors.initials: L
authors.lastname: Vasilenko
authors.affiliation: Heart Institute, Hillel Yaffe Medical Center, Hadera, affiliated to the Rappaport Medical School, The Technion- Israel Institute of Technology, Haifa, Israel.
authors.forename: Aya
authors.initials: A
authors.lastname: Asif
authors.affiliation: Heart Institute, Hillel Yaffe Medical Center, Hadera, affiliated to the Rappaport Medical School, The Technion- Israel Institute of Technology, Haifa, Israel.
authors.forename: Avraham
authors.initials: A
authors.lastname: Shotan
mesh_terms: D000368:Aged; D017023:Coronary Angiography / Q000379:methods; D003326:Coronary Circulation / Q000502:physiology*; D003327:Coronary Disease / Q000601:surgery*; D004562:Electrocardiography / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000601:surgery*; D062645:Percutaneous Coronary Intervention; D015607:Stents / Q000009:adverse effects*; D013927:Thrombosis / Q000601:surgery*; D016896:Treatment Outcome
keywords: Primary percutaneous coronary intervention; ST-elevation myocardial infarction; Stent thrombosis; Thrombolysis