Role of Intracoronary Thrombolytic

Therapy During Percutaneous

Coronary Interventions

Dr. Sanjeev Kumar Agarwal MBBS, MD, DM, FACC, CBCCT

Consultant Interventional Cardiologist

Rashid Hospital, Dubai, UAE

skacardio@yahoo.com @skacardio

No conflict of interest in the context of the subject of this presentation

Clinical data

Mr. SAHA

70-yrs-old, Angina on exertion

DM (diet control), dyslipidemia

Cardiac examination: PR 74 bpm, BP 146/66 mm Hg.

Investigations: ECG: NSR, loss of R wave in III and aVF

Hb:11.9 g/L, platelets: 198 x100/µL, creatinine 1.4 mg%

DSE: positive for inducible ischemia

Coronary angiography: Normal LM, 80% Proximal and mid-

LAD disease-calcific, 90% diag lesion, 90% lesion at ostium

of OM and 80% PDA Syntax score=29, Euroscore II =1.12

After consultation, multivessel PCI was preferred to CABG

Interventional Management .1

Elective PCI 7 Fr femoral sheath, UFH 100 IU/Kg, DAPT (ASA + clopidogrel)

2.25x23 mm EES

Interventional Management .2

LAD Stent: 2.5x28 EES OM stent: 2.5x23 EES

Interventional Management .3

Management of catastrophe

Check for ACT and more heparin

Balloon inflations

GP IIb/IIIa inhibitors

Manual thrombectomy

Emergency CABG

Management of catastrophe .2

IC Thrombolytic therapy

GDR, aged 35 y,

Severe chest pain: 2h,

first episode, Ch.

smoker

Exam: PR: 80 bpm, BP:

85/60 mmHg, CVS: no

murmur, Lungs:

bibasilar crept

Strategy for treatment Options

Treat the culprit- only LAD PCI

LAD PCI ► thrombus suction for LCx

Thrombus suction for LCx ► LAD PCI

Wire both together / one at a time

? Emergency CABG

Confusion in Reperfusion

What I did?

5 min

• IABP

• Left guide cath

• I / C tPA: 20 mg over 4-5 min.

LAD PCI

LAD PCI ---- No

What I did

• Another 10 mg I/C tPA Thrombus aspiration

LAD PCI

Stent 4x15 mm Final Result

Agarwal: Cath and Cardiovasculat Inter-2011, 78, 72-75

Further course

Uneventful recovery

Asymptomatic in follow-up

Message IC administration of t-PA leads to rapid and

complete dissolution of coronary Thrombus

Pharmaco-invasive rather than Invasive only strategy successful in second patient