What is the clinical evidence from this study?

Study design: Case Report. Population: Coronary embolism after mechanical aortic valve replacement (n=1). Intervention: Intracoronary recombinant human prourokinase (rh-proUK). Primary outcome: Restoration of coronary flow.

What question did this study set out to answer?

To evaluate the efficacy of intracoronary prourokinase as a treatment for coronary embolism after aortic valve replacement.

April 20, 2026Journal of Cardiothoracic Surgery0 citationsOpen Access

Intracoronary prourokinase for coronary embolism after aortic valve replacement: a viable treatment option?

HFHongyan FanJiaxing University HWHuawei WangSoochow University CHChaojie HeJiaxing University

Key Result

Intracoronary administration of 20 mg recombinant human prourokinase successfully enabled complete thrombus extraction and restored TIMI 3 flow without stent implantation in a patient with refractory coronary embolism.

Key Points

To evaluate the efficacy of intracoronary prourokinase as a treatment for coronary embolism after aortic valve replacement.
Case report of a 67-year-old man with ST-segment elevation myocardial infarction after mechanical AVR.
Intracoronary administration of 20 mg rh-proUK via microcatheter.
Coronary angiography performed to assess occlusion and flow.
Effective thrombus aspiration resulted in complete restoration of TIMI 3 flow.
No residual stenosis observed, avoiding the need for stent implantation.
Emphasized the necessity of strict lifelong anticoagulation in patients with mechanical valves.

Study Design

Type

Case Report (n=1)

Multicenter

Structured PICO

Does intracoronary prourokinase improve coronary flow in a patient with coronary embolism after aortic valve replacement?

Population

1 67-year-old man with a history of mechanical aortic valve replacement presenting with inferior ST-segment elevation myocardial infarction due to coronary embolism after discontinuing warfarin.

Intervention

Intracoronary administration of 20 mg recombinant human prourokinase (rh-proUK) via a microcatheter.

Outcome

Restoration of coronary flow (TIMI flow grade) and thrombus extraction.surrogate

Intracoronary prourokinase may serve as an effective rescue therapy for refractory coronary embolism when conventional interventions fail, enabling stent-free revascularization.

Limitations

Intracoronary imaging was not performed, limiting definitive distinction between embolic occlusion and other mechanisms.
Direct visualization of thrombus on the prosthetic valve was not obtained.

Abstract

Coronary embolism (CE) is a rare but life-threatening cause of acute myocardial infarction (AMI) in patients following mechanical aortic valve replacement (AVR), often resulting from subtherapeutic anticoagulation. Due to the absence of consensus management guidelines, treatment strategies remain individualized. A 67-year-old man with a history of mechanical AVR presented with inferior ST-segment elevation myocardial infarction after discontinuing warfarin for one week, resulting in subtherapeutic anticoagulation. Emergency coronary angiography revealed abrupt occlusion of the mid-right coronary artery (RCA) without underlying atherosclerosis. Targeted intracoronary administration of 20 mg recombinant human prourokinase (rh-proUK) via a microcatheter enabled effective thrombus aspiration and complete restoration of TIMI 3 flow without residual stenosis, thereby avoiding stent implantation. This case demonstrates that intracoronary rh-proUK administration serves as an effective rescue therapy for refractory CE when conventional interventions fail, enabling stent-free revascularization. The findings also underscore the importance of strict lifelong anticoagulation in patients with mechanical valves.

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