The Korean Journal of Medicine

The Korean Association of Internal Medicine (대한내과학회)
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Intracoronary Thrombolysis and Delayed Percutaneous Coronary Intervention for the Treatment of Large Coronary Thrombi in a Patient with Polycythemia Vera

적혈구 증가증에서 거대 심혈관 혈전의 심혈관내 혈전 용해 및 혈관 성형술

  • Lee, Hye Young (Division of Cardiology, Department of Internal Medicine, Sanggye Paik Hospital, Inje University) ;
  • Kim, Byung Ok (Division of Cardiology, Department of Internal Medicine, Sanggye Paik Hospital, Inje University) ;
  • Byun, Young Sup (Division of Cardiology, Department of Internal Medicine, Sanggye Paik Hospital, Inje University) ;
  • Goh, Choong Won (Division of Cardiology, Department of Internal Medicine, Sanggye Paik Hospital, Inje University) ;
  • Kim, Jeong Hoon (Division of Cardiology, Department of Internal Medicine, Sanggye Paik Hospital, Inje University)
  • 이혜영 (인제대학교 의과대학 상계백병원 심장내과) ;
  • 김병옥 (인제대학교 의과대학 상계백병원 심장내과) ;
  • 변영섭 (인제대학교 의과대학 상계백병원 심장내과) ;
  • 고충원 (인제대학교 의과대학 상계백병원 심장내과) ;
  • 김정훈 (인제대학교 의과대학 상계백병원 심장내과)
  • Received : 2013.12.02
  • Accepted : 2014.03.28
  • Published : 2014.12.01
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Abstract

The benefit of thrombus aspiration during percutaneous coronary intervention in patients with acute myocardial infarction (AMI) is well established; however, the optimal management strategy for patients with a large thrombus burden after repeated thrombectomy (i.e., "failed" thrombectomy) is unknown. Here, we report the case of a 67-year-old male with polycythemia vera who was treated with intracoronary thrombolytic therapy in combination with mechanical thrombectomy. Repeated aspiration thrombectomy did little to reduce the coronary thrombus burden; thus, intracoronary urokinase infusions were applied to the thrombus-containing lesion. Repeat coronary angiography 4 days later revealed markedly improved antegrade flow in the infarct-related artery, and successful revascularization was performed. This case demonstrates the potential utility of intracoronary thrombolytic therapy for select AMI patients with a large thrombus burden who are in a hypercoagulable state.

Keywords

References

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