Coronary Pulsed‐Spray: Accelerated Pharmacomechanical Intravascular Thrombolysis in Acute Coronary Events Followed by Immediate Endovascular Therapy

Coronary thrombolysis and percutaneous coronary angioplasty (PTCA) have improved the short— and long‐term prognosis in patients with acute coronary events. This study proposes a rapid approach to lyse the thrombotic material present in the ischemic related vessel (IRV) and immediately apply the most appropriate therapy based on the underlying anatomy. Fifty patients, 24 with myocardial infarction (MI) and 26 with unstable angina (UA), were treated. Once the IRV was identified, a 15 multiple side‐hole infusion catheter was placed across the clot matrix and 25,000 units of urokinase were administered forcefully every 30 seconds in pulses of 1 mL, using a 1‐mL syringe to obtain a spray effect until a total of 1,000,000 units were completed in 20 minutes. Immediate results after the pulsed‐spray thrombolysis (PST): The % stenosis decreased from 96 ± 9 to 49 ± 37 and the flow increased from TIMI 0.06 ± 0.02 to TIMI 2.7 ± 0.6, P < 0.001. Therapeutic procedures immediately after the PST: 30 patients were treated with percutaneous transluminal coronary angioplasty (PTCA) followed by stent deployment, 8 with conventional PTCA, 10 received medical therapy, and 1 underwent elective surgical revascularization. Two patients had minor self‐limited gingival bleeding. One patient had a groin hematoma, and another patient developed a right femoral artery pseudoaneurysm, corrected surgically. One patient with unstable angina died with no‐reflow phenomenon in the circumflex coronary artery. Twenty four patients (48%) have been followed up (11 ± 3.6 months), all in functional Class I–II. Eight (16%) who underwent repeat coronary angiography 4 ± 2.2 months post‐PST, had TIMI 3 flow in the IVR. PST applied to the coronary circulation in acute ischemic events is a method able to lyse the thrombotic material associated with the complicated plaque. This approach allows better selection of an immediate endovascular therapy for each patient based on the underlying anatomy and results in a shorter hospital stay. (J Interven Cardiol 2000; 13:19–26)