Angioplasty after thrombolysis

Ueda T, Sakaki S, Nochide I, Kumon Y, Kohno K, Ohta S. Angioplasty after intra-arterial thrombolysis for acute occlusion of intracranial arteries. Stroke 1998 29 2568-2574. 

Abou-Chebl A, Bajzer CT, Krieger DW, Furlan AJ, Yadav JS. Multimodal therapy for the treatment of severe ischemic stroke combining GPEh/IIIa antagonists and angioplasty after failure of thrombolysis. Stroke 2005 36 2286-2288. 

In a comparison of thrombolysis and angioplasty, reinfarction after thrombolysis (6.3% compared with angioplasty 1.6%) worsens the patient s outcome (20). The improved outcome here was driven by a reduction in the rate of reinfarction. If coronary blood flow by cine frame count improved in the culprit artery, the flow also improved in the nonculprit arteries (19). This suggests that the active inflammatory infiltrate is a dynamic phenomenon. 

With completion of the GISSI and ISIS-2 trials in the mid-1980s, intravenous fibrinolysis was rapidly adopted as the first-line reperfusion strategy for myocardial infarction (10,11). However, the early studies of intracoronary thrombolysis had shown that most patients still had a severe residual stenosis after successful thrombolysis (12). Many investigators remained concerned about the risk of reocclusion of the infarct vessel and thought that angioplasty should be performed routinely after thrombolysis even in asymptomatic patients. This became known as the Strep-and-Stretch approach. 

Williams DO, Ruocco NA, Forman S, and the TEVII Investigators. Coronary angioplasty after recombinant tissue-type plasminogen activator in acute myocardial infarction a report from the Thrombolysis in Myocardial Infarction (TIMI) trial. J Am Coll Cardiol 1987 10 45B-50B. 

Topol EJ, Califf RM, George BS, et al., and the Thrombolysis and Angioplasty in Acute Myocardial Infarction Study Group. A randomized trial of immediate vs. delayed elective angioplasty after intravenous tissue plasminogen activator in acute myocardial infarction. N Engl J Med 1987 317 581-588. 

Brochier, M. L. Evaluation of flurbiprofen for prevention of reinfarction and reocclusion after successful thrombolysis or angioplasty in acute myocardial infarction. The Flurbiprofen French Trial, Eur. Heart J. 1993, 14, 951-957. 

De ite differmces in their mechanisms of action and in vitro activities, pentasaccharide, DX-9065a and TAP have been shown to be effective antithrombotic agents in experimental models of venous thrombosis, coronary artery occlusion, arterial thrombolysis and acute reocclusion, restenosis after angioplasty, dialysis, and DIG. Pentasaccharide has also demonstrated measurable antithrombotic effects in human trials. Both TAP and DX-9065a produce measurable in vitro anticoagulant effects. In contrast, pentasaccharide does not produce an anticoagulant effect by the typical clot based assays. Thus, with fector Xa inhibitors there is not necessarily a correlation between current lab assays and antithrombotic efficacy as there is with heparin. 

Harrington RA, Sane DC, Califf RM, Sigmon KN, Abbottsmith CW, Candela RJ, Lee KL, Topol EJ. Clinical importance of thrombocytopenia occurring in the hospital phase after administration of thrombolytic therapy for acute myocardial infarction. The Thrombolysis and Angioplasty in Myocardial Infarction Study Group. J Am CoU Cardiol 1994 23(4) 891-8. 

The results of serial determinations of serum Mn-SOD for the 29 patients are shown in Fig. 18. Figure 18A shows results for 23 reperfused patients, whereas Fig. 18B depicts six cases without reperfusion. In four of the latter patients either intracoronary thrombolysis or percutaneous transluminal coronary angioplasty was unsuccessfully employed. In two cases, reocclusion occurred after reperfusion. This was confirmed later by coronary angiography during the convalescent... 

In the UAE, as well as many countries in western Europe and North America, primary PCI for treatment of patients with STEMI was and still is not readily available in many hospitals. We believe the case for performing primary PCI in most such patients is not yet compelling. The impact of time to treatment on mortality after prehospital thrombolysis or primary angioplasty (CAPTIM study) has shown that prehospital thrombolysis may be preferable to primary PCI for patients treated within the first 2 hours after onset of symptoms. Conversely, the DANish Multi-Center Randomized Study on Eibrinoljdic Therapy versus Acute Myocardial Infarction (DANAMI-2) report showed a reduction in cardiac events in patients treated with primary angioplasty compared with those treated with fibrinolytic agents for STEMI (13,14). The critics of that study have pointed out that the trial included only 37% of the population with STEMI and excluded patients with... 

Veen G, de Boer MJ, Zijlstra F, Verheugt EWA. Improvement in three-month angiographic ontcome snggested after primary angioplasty for acnte myocardial infarction (Zwolle trial) compared with successful thrombolysis (APRICOT trial). Am J Cardiol 1999 84 763-767. 

Kleiman NS, Ohman EM, Califf RM, George BS, Kereiakes D, Aguirre FV, Weisman H, Schaible T, Topol EJ. Profound inhibition of platelet aggregation with monoclonal antibody 7E3 Eab after thrombolytic therapy. Results of the Thrombolysis and Angioplasty in Myocardial Infarction (TAMl) 8 Pilot Study. J Am CoU Cardiol. 1993 22 381-389. 

De Luca G, Parodi G, Antoniucci D. Safety and benefits of protamine administration to revert anticoagulation soon after coronary angioplasty. A meta-analysis. J Thromb Thrombolysis 2010 30 452-8. 

The most common lesion treated in the authors center is femoral artery thrombosis complicating catheterization, especially for balloon angioplasty of the aortic arch or aortic valve. These procedures require the insertion of a large balloon, which is currently mounted on large shafts. Initially a local low-dose approach from the opposite groin was preferred, but now systemic therapy is frequently used if there are no contraindications. Local low-dose thrombolysis is used for thrombosis of Blalock-Taussig shunts, dialysis fistula, pulmonary artery thrombosis, iliofemoral thrombophlebitis, aortic thrombosis in neonates, and brachial artery occlusion after supracondylar fracture. 

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