Role of Intracoronary Thrombolytic Therapy During ... · Hb:11.9 g/L, platelets: 198 x100/µL,...
Transcript of Role of Intracoronary Thrombolytic Therapy During ... · Hb:11.9 g/L, platelets: 198 x100/µL,...
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
[email protected] @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