Intracoronary arterial retrograde thrombolysis with percutaneous coronary intervention: a novel use of thrombolytic to treat acute ST-segment elevation myocardial infarction.

Figures

• 

  Figure 1.. Pattern diagram of intracoronary artery retrograde thrombolysis system.

• 

  Figure 2.. Comparison of antegrade thrombolysis vs. retrograde thrombolysis in acute circumflex arterial occlusion. (A): The baseline angiogram shows total occlusion of the circumflex artery. The arrow showed the occlusion; (B): During transcatheter antegrade thrombolysis, the thrombolytic agent filled the vessel proximal to the stenosis. Thrombolytic agent injected antegrade was completely cleared after 1.5 seconds, the occlusion showed no change. The fine arrow indicated the tip of the microcatheter, and the coarse arrow showed the thrombolytic agent with contrast agent to fill the lumen; (C): In retrograde thrombolysis, the thrombolytic agent remained visible in the vessel distal to the occlusion. The fine arrow indicated the tip of the microcatheter, and the coarse arrow showed the thrombolytic agent with contrast agent to fill the lumen; (D): Using retrograde thrombolysis, antegrade angiography was used to clearly display the lesion; (E): The culprit lesion is seen in the distal segment of the LCX; and (F): Stent was placed in the circumflex branch to achieve revascularization. LCX: left circumflex branch.

• 

  Figure 3.. Coronary angiogram in acute anterior myocardial infarction. (A): The basal angiogram showed total occlusion of the left anterior descending artery proximal segment with thrombus image. The arrow showed the occlusion; (B): The procedure of intracoronary artery retrograde thrombolysis through the microcatheter. The distal thrombus was gradually dissolved. The fine arrow indicated the tip of the microcatheter, and the coarse arrow showed the thrombolytic agent with contrast agent to fill the lumen; (C): After thrombolysis, the culprit lesion (arrow) was observed in the proximal segment of the descending branch; and (D): A stent was implanted in the anterior descending branch to achieve revascularization.

• 

  Figure 4.. Coronary angiogram in acute right coronary artery myocardial infarction. (A): The basal angiogram showed total occlusion of the RCA proximal-middle segment with thrombus image. The arrow showed the occlusion; (B): The process of intracoronary artery retrograde thrombolysis through the microcatheter. The fine arrow indicated the tip of the microcatheter, and the coarse arrow showed the thrombolytic agent with contrast agent to fill the lumen; (C): After thrombolysis, the culprit lesion (arrow) was observed in the proximal-middle segment of the RCA; and (D): A stent was implanted in the RCA to achieve revascularization. RCA: right coronary artery.