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KMID : 0882420140870060728
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Korean Journal of Medicine
2014 Volume.87 No. 6 p.728 ~ p.732
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Intracoronary Thrombolysis and Delayed Percutaneous Coronary Intervention for the Treatment of Large Coronary Thrombi in a Patient with Polycythemia Vera
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Lee Hye-Young
Kim Byung-Ok
Byun Young-Sup
Goh Chong-Won
Kim Jeong-Hoon
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Abstract
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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.
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KEYWORD
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Thrombolytic therapy, Myocardial infarction, Percutaneous coronary intervention
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