Circulation, Vol 73, 653-661, Copyright © 1986 by American Heart Association
BG Brown, CA Gallery, RS Badger, JW Kennedy, D Mathey, EL Bolson and HT Dodge
Thrombolytic recanalization of the obstructed coronary lumen was studied in
32 patients receiving intracoronary streptokinase for 60 to 90 min during
acute myocardial infarction. The process was viewed at high arteriographic
magnification and was quantified with computer- assisted measurements from
repeated single-plane views. The variability of the method for this
application was 0.15 to 0.18 mm on minimum diameter estimates. Structural
details were seen that are not commonly appreciated at conventional
magnification. The recanalized lumen appears to form along an interface
between the thrombus and the vessel wall, progressively enlarging its
minimum arteriographic diameter to 0.65 +/- 0.24 mm (+/- 1 SD) at the end
of the short-term infusion of streptokinase reflecting a final percent
stenosis of 77 +/- 10%. In nine infarct lesions found patent 5 +/- 3 weeks
later, the recanalized lumen further improved an average of 0.34 mm in
minimum diameter (p less than .005) and 13% stenosis (p less than .01). A
thin film of contrast medium surrounding the obstructing thrombus faintly
defined the boundaries of the original atherosclerotic lumen in all but two
cases. The "original stenosis" measured 1.25 +/- 0.32 mm in minimum
diameter and 56 +/- 14% stenosis when first visualized; it was unchanged
throughout the course of infusion of streptokinase. In five patients
catheterized 10 +/- 12 weeks before their infarction, the original stenosis
averaged 1.15 +/- 0.22 mm in the preinfarct angiogram, as compared with
1.17 +/- 0.23 mm in its faintly defined form during thrombolytic therapy (p
= NS). In 10 cases, this original lesion was less than a 50% stenosis, and
in 21 cases less than 60%.(ABSTRACT TRUNCATED AT 250 WORDS)
ARTICLES
Incomplete lysis of thrombus in the moderate underlying atherosclerotic lesion during intracoronary infusion of streptokinase for acute myocardial infarction: quantitative angiographic observations
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