Korean J Med.  2014 Dec;87(6):728-732. 10.3904/kjm.2014.87.6.728.

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

• Lee HY
• Kim BO
• Byun YS
• Goh CW
• Kim JH

• KMID: 2269370
• DOI: http://doi.org/10.3904/kjm.2014.87.6.728

Abstract

The benefit of thrombus aspiration during percutaneous coronary intervention in patients with acute myocardial infarction (AMI) 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 was treated with intracoronary thrombolytic therapy in combination with mechanical thrombectomy. Repeated aspiration thrombectomy did little to reduce the coronary thrombus burden; thus, intracoronary urokinase infusions were applied to the thrombus-containing lesion. 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 therapy for select AMI patients with a large thrombus burden who are in a hypercoagulable state.

Keyword

Thrombolytic therapy; Myocardial infarction; Percutaneous coronary intervention

MeSH Terms

Aged
Arteries
Coronary Angiography
Humans
Male
Myocardial Infarction
Percutaneous Coronary Intervention*
Polycythemia Vera*
Thrombectomy
Thrombolytic Therapy
Thrombosis
Urokinase-Type Plasminogen Activator
Urokinase-Type Plasminogen Activator