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적혈구 증가증에서 거대 심혈관 혈전의 심혈관내 혈전 용해 및 혈관 성형술

Intracoronary Thrombolysis and Delayed Percutaneous Coronary Intervention for the Treatment of Large Coronary Thrombi in a Patient with Polycythemia Vera

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is well established; however, the optimal management strategy for patients with a large thrombus burden after repeated thrombectomy(i.e., “failed” thrombectomy) is unknown. Here, we report the case of a 67-year-old male with polycythemia vera who wastreated with intracoronary thrombolytic therapy in combination with mechanical thrombectomy. Repeated aspiration thrombectomydid little to reduce the coronary thrombus burden; thus, intracoronary urokinase infusions were applied to the thrombus-containinglesion. Repeat coronary angiography 4 days later revealed markedly improved antegrade flow in the infarct-related artery,and successful revascularization was performed. This case demonstrates the potential utility of intracoronary thrombolytic therapyfor select AMI patients with a large thrombus burden who are in a hypercoagulable state.

Abstract

is well established; however, the optimal management strategy for patients with a large thrombus burden after repeated thrombectomy(i.e., “failed” thrombectomy) is unknown. Here, we report the case of a 67-year-old male with polycythemia vera who wastreated with intracoronary thrombolytic therapy in combination with mechanical thrombectomy. Repeated aspiration thrombectomydid little to reduce the coronary thrombus burden; thus, intracoronary urokinase infusions were applied to the thrombus-containinglesion. Repeat coronary angiography 4 days later revealed markedly improved antegrade flow in the infarct-related artery,and successful revascularization was performed. This case demonstrates the potential utility of intracoronary thrombolytic therapyfor select AMI patients with a large thrombus burden who are in a hypercoagulable state.

참고문헌 (9)

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  3. Antman EM, "ACC", AHA guidelines for the management of patients with ST-elevation myocardial infarction--executive summary. A report of the American College of Cardiology, J Am Coll Cardiol, pp.2004, 44[DOI]
  4. O’Neill W, "A prospective randomized clinical trial of intracoronary streptokinase versus coronary angioplasty for acute myocardial infarction", N Engl J Med, 314, pp.812~818 (1986)
  5. Goudreau E, "Intracoronary urokinase as an adjunct to percutaneous transluminal coronary angioplasty in patients with complex coronary narrowings or angioplasty-induced complications", Am J Cardiol, 69, pp.57~62 (1992)
  6. Ishibashi F, "Combined revascularization strategy for acute myocardial infarction in patients with intracoronary thrombus: preceding intracoronary thrombolysis and subsequent mechanical angioplasty", Jpn Circ J, 65, pp.251~256 (2001)
  7. Sezer M, "Intracoronary streptokinase after primary percutaneous coronary intervention", N Engl J Med, 356, pp.1823~1834 (2007)
  8. Kelly RV, "Safety of adjunctive intracoronary thrombolytic therapy during complex percutaneous coronary intervention: initial experience with intracoronary tenecteplase", Catheter Cardiovasc Interv, 66, pp.327~332 (2005)
  9. Cafri C, "Improved procedural results in coronary thrombosis are obtained with delayed percutaneous coronary interventions", J Invasive Cardiol, 16, pp.69~71 (2004)

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