Abstract
A brief description of recanalization of the thrombotic coronary artery is provided, including the historical background and our own first experience of recanalization during the event of an acute catheter complication. Mechanical recanalization of occluded coronary arteries as initially performed by us is described. The subsequent use of intracoronary infusion of streptokinase is also detailed. An account is given of the angiographic and clinical results in a study of 59 patients. We then consider the encountered and potential complications of percutaneous transluminal coronary artery recanalization (PTCR) based on a study of 232 acute infarction patients treated in four different centers. A discussion of the potential benefits of the intervention is provided, including lower mortality in a patient subgroup that underwent successful recanalization, as well as improved left ventricular function as seen angiographically in successfully recanalized patients. Use of intracoronary thallium injections before and after recanalization is discussed. It is stated that precise delineation of efforts will require randomized control trials. Finally, we provide some suggestions as to the potential follow-up treatment and future development of the technique.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Bolton HE, Tapia FA, Cabral H, Riera R, Mazel MS (1961) Removal of acute coronary thrombus with fibrinolysin-in vivo experiment. JAMA 175:307–310
Boucek RJ, Murphy WP Jr (1960) Segmental perfusion of the coronary arteries with fibrinolysin in man following a myocardial infarction. Am J Cardiol 6:525–533
Moschos CB, Burke WM, Lehan PH, Oldewurtel HA, Regan TJ (1970) Thrombolytic agents and lysis of coronary artery thrombosis. Cardiovasc Res 4:228–234
Kordenat RK, Kezdi P, Powley D (1972) Experimental intracoronary thrombosis and selective in situ lysis by catheter technique. Am J Cardiol 30:640–644
Kanmatsuse K, Lando U, Mercier JC, Fishbein MC, Swan HJC, Ganz W (1979) Rapid lysis of coronary thrombi by local application of fibrinolysin. Circulation (Suppl) 60:II-216
Chazov EI, Mateeva LS, Mazaev AV, Sargin KE, Sadovshaya M, Ruda Y (1976) Intracoronary administration of fibrinolysin in acute myocardial infarction. Ter Arkh 48:8–19
Blanke H, Rentrop P, Karsch KR, Kreuzer H (1979) Coronary angiographic and ventriculographic findings in the acute and chronic stage of myocardial infarction. Circulation (Suppl) 60:II-69
Rentrop P, De Vivie ER, Karsch KR, Kreuzer H (1978) Acute coronary occlusion with impending infarction as an angiography complication relieved by a guidewire recanalization. Clin Cardiol 1:101–107
Rentrop P, Blanke H, Karsch KR, Kreuzer H (1979) Initial experience with transluminal recanalization of the recently occluded infarct-related coronary artery in acute myocardial infarction. Comparison with conventionally treated patients. Clin Cardiol 2:92–105
Rentrop P, Planke H, Karsch KR, Wiegand V, Köstering H, Oster H, Leitz K (1979) Acute myocardial infarction: Intracoronary application of nitroglycerin and streptokinase. Clin Cardiol 2:354–363
Rentrop P, Blanke H, Karsch KR, Kaiser H, Kostering H, Leitz K (1981) Selective intracoronary thrombolysis in acute myocardial infarction and unstable angina pectoris. Circulation 63:307–317
Rutsch W, Schartl M, Mathey D, Kuck K, Merx W, Dörr R, Rentrop P, Blanke H (1982) Percutaneous transluminal coronary recanalization: Precedure, results and acute complications. Am Heart J 102:1178–1180
Lang TW, Corday E, Gold H, Meerbaum S, Rubins S, Costantini C, Hirose S, Osher J, Rosen W (1974) Consequences of reperfusion after coronary occlusion. Effects on hemodynamic and regional myocardial metabolic function. Am J Cardiol 33:69–81
Merx W, Dörr R, Rentrop P, Blanke H, Karsch KR, Mathey DG, Kremer P, Rutsch W, Schmutzler H (1982) Evaluation of effectiveness of intracoronary streptokinase infusion in acute myocardial infarction. Postprocedure management and hospital course in 204 patients. Am Heart J 102:1181–1187
Rentrop P, Blanke H, Karsch KR (1982) Effects of non-surgical coronary reperfusion on the left ventricle in human subjects compared with conventional treatment. Am J Cardiol 49:1–8
Reduto LA, Smalling RW, Freund GC, Gould KL (1981) Intracoronary infusion of streptokinase in patients with acute myocardial infarction: Effects of reperfusion on left ventricular performance. Am J Cardiol 48:403–409
Rentrop P, Blanke H, Karsch KR, Rutsch W, Schartl M, Merx W, Dörr R, Mathey D, Kuck K (1982) Changes in left ventricular function after intracoronary streptokinase infusion in evolving myocardial infarction. Am Heart J 102:1188–1193
Markis JE, Malagold M, Parker JA, Silverman KJ, Barry WH, Als AV, Paulin S, Grossman W, Brauwald E (1981) Myocardial salvage after intracoronary thrombolysis with streptokinase in acute myocardial infarction. N Eng J Med 305:777–782
Mathey DG, Rodewald G, Rentrop P, Leitz K, Merx W, Messmer BJ, Rutsch W, Bucherl ES (1982) Intracoronary streptokinase thrombolytic recanalization and bypass of remaining atherosclerotic stenosis in acute myocardial infarction: Complementary combined approach, effecting reduced infarct size, preventing reinfarction, and improving left ventricular function. Am Heart J 102:1194–1201
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Rentrop, P., Blanke, H. Percutaneous transluminal coronary artery recanalization in evolving myocardial infarction. Cardiovasc Intervent Radiol 5, 194–196 (1982). https://doi.org/10.1007/BF02552309
Issue Date:
DOI: https://doi.org/10.1007/BF02552309