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PubMed1998

Thrombosis with outflow obstruction delays thrombolysis and results in chronic wall thickening of rat veins.

PURPOSE: An in vivo model of acute deep venous thrombosis was developed in rats to assess the role of venous thrombosis and outflow obstruction in recanalization and development of secondary wall changes. METHODS: The left femoral veins of male Sprague-Dawley rats were thrombosed either by means of proximal ligation (obstruction, group A, n = 38) or by means of temporary 24-hour occlusion with a microvascular clamp (unobstructed, group B, n = 20). Right femoral veins served as controls. The rats were killed at intervals over 5 weeks. Wall thickness was compared among groups by means of counting of cells on representative sections through the midvein area. Thrombi were indirectly quantitated with a radiolabeled fibrinogen assay in a parallel series of rats. RESULTS: Control veins showed no evidence of cellular or structural changes. Early thrombus extension was seen in group A (peak at day 4) followed by recanalization after 2 weeks. Group A veins had marked wall thickening (27 +/- 7 vs 6 +/- 2 cells, p < 0.01, peak at 10 days) consisting of smooth muscle-type, neointimal, and medial cellular proliferations. Within 2 to 3 weeks, local neovascular channels had grown to bypass the outflow obstruction, and resumption of normal cephalad flow was seen. At the same time neointimal proliferation regressed, but medial cellular growth persisted, resulting in chronic wall thickening (11 +/- 3 vs 5 +/- 1 cells, p < 0.01, after 21 days). In contrast, group B veins exhibited no thrombus extension, had significantly less wall thickening (13 +/- 2 vs 5 +/- 1 cells, p < 0.01, peak at 4 days), and did not induce growth of local collateral blood vessels. Within 2 weeks, group B veins regained normal appearance and resumed normal flow. CONCLUSIONS: Thrombosis of rat femoral veins without chronic obstruction results in rapid lysis of thrombus and transient proliferative changes. In contrast, thrombosis with chronic outflow obstruction results in delayed recanalization, early extension of thrombus, and development of vigorous and persistent proliferative cellular responses. Thrombus-induced chronic wall thickening may be an important factor in development of postthrombotic venous insufficiency.

Animals↗
PubMed1990

Percutaneous atherectomy with the Kensey catheter: early and midterm results in femoropopliteal occlusions unsuitable for conventional angioplasty.

Forty-six femoropopliteal occlusions in 44 patients (aged 45-95 years) were recanalized with the percutaneous rotating tip atherectomy catheter completed by balloon dilatation. Thirty-one patients had tight intermittent claudication of the lower limbs, five had resting pain and 10 had skin disorders. The length of the occlusion ranged from 2 to 24 cm. Of 46 procedures, 40 (87%) were immediately successful (increase of mean Doppler systolic ankle-arm index from 0.44 to 0.89) and six (13%) were failures. In two it was impossible to pass through the lesion and in four arterial perforation occurred without any clinical consequences. Of the six failures, five occurred in calcified arteries. Five recanalizations (11%) reoccluded within 48 hours, bringing the total number of early failures to 11. Of these 11 failures, nine were treated by femoropopliteal vein bypass and two by medical treatment only. Two postoperative asymptomatic posterior tibial artery embolisms were treated medically, and one popliteal artery embolism was treated using a Fogarty catheter. At the present time, 25 of 35 primary successes had been followed for six months, and 20 for 12 months with primary patencies 18 of 25 (72%) and 14 of 20 (70%), respectively. If massively calcified lesions are excluded, femoropopliteal recanalization with the percutaneous rotary Kensey atherectomy catheter followed by balloon catheter dilatation is efficacious and reliable with an 80% primary success rate and a 70% patency rate at one year.

Aged↗
PubMed2002

Ultrasound-enhanced thrombolysis for stroke: clinical significance.

In the pivotal clinical trials of intravenous tissue plasminogen activator (TPA) therapy for ischemic stroke, a low rate of early arterial recanalization was suspected due to the small numbers of patients who had early dramatic clinical improvement. TPA activity can be enhanced with ultrasound including 2 MHz transcranial Doppler (TCD). TCD can identify residual signals around the thrombus with the thrombolysis in brain ischemia (TIBI) flow grading system and therefore expose more thrombus surface to circulating TPA. A phase I clinical study, monitoring TPA infusion with diagnostic ultrasound resulted in an unexpectedly high rate of complete recanalization (36% of proximal middle cerebral artery (MCA) occlusions) and associated early dramatic clinical recovery (24%) among treated patients. The external application of diagnostic ultrasound in our studies raised the possibility that a synergistic TPA and ultrasound action accelerated flow improvement and achieved faster and more complete thrombus dissolution as predicted from experimental models. The CLOTBUST (combined lysis of thrombus in brain ischemia using transcranial ultrasound and systemic TPA) trial is testing this hypothesis in a phase II clinical randomized multi-center setting. Dramatic clinical recovery from stroke and complete recanalization shortly after TPA bolus are feasible goals for thrombolysis assisted with TCD monitoring.

Brain Ischemia↗
PubMed2005

Portal vein thrombosis: etiology, diagnostic strategy, therapy and management.

Myeloproliferative disorder, liver cirrhosis with portal hypertension, deficiency of natural anticoagulant proteins, gene mutation and hepatocellular carcinoma are the most frequent causes of portal vein thrombosis (PVT). Higher accuracy of the diagnostic methods is the reason why today the cause of PVT can be found more frequently. With imaging methods, PVT with or without cavernous transformation can be diagnosed. Fresh thrombus can be undetected in sonography due to the low echogenity but can be recognized in color Doppler sonography, especially with contrast-enhancing agent. Contrast-enhanced 3D MR angiography allows a comparable accuracy in the detection of PVT as digital subtraction angiography. Therapeutical options of PVT consist of mechanical recanalization of the portal vein, local fibrinolysis with or without placement of transjugular intrahepatic portosystemic stent shunt (TIPS), combination of mechanical recanalization and local fibrinolysis, systemic thrombolytic therapy, anticoagulation alone and surgical thrombectomy. Once PVT is found in sonography, Doppler sonography may be performed in order to distinguish benign from malignant thrombus. If further information is needed, MR angiography or contrast enhanced CT is the next step. If these tests are unsatisfactory, digital subtraction angiography should be performed. Until the early nineties, shunt surgery was recommended in patients with PVT who bled despite endoscopic treatment. Today, in symptomatic noncavernomatous PVT, recanalization with local methods is recommended. Additional implantation of TIPS should be performed when the patient is cirrhotic. In recent PVT in non-cirrhotic patients anticoagulation alone is recommended. It is expected that in old PVT anticoagulation can prevent further extension of the thrombus.

Animals↗
PubMed1999

Paternity after bilateral vasectomy.

OBJECTIVES: To determine whether the occurrence of recanalization depends on the technique of vasectomy. MATERIALS AND METHODS: A survey was conducted among Dutch urologists using a questionnaire in which information was gathered about the surgical procedure, postoperative complications, results of semen analysis after vasectomy, time between vasectomy and occurrence of paternity, results of semen analysis after paternity, performance of revasectomy, results of histological examination of the revasectomy specimen and whether the event had changed the protocol of the urologists. RESULTS: In all, 32 cases of paternity after vasectomy were registered. Surgical techniques and the criteria for a successful vasectomy differed among the responding urologists. There was a difference in time to paternity between men who did and did not correspond with the criteria. In most cases, semen analysis after paternity showed numerous motile sperm. Six men initiated litigation after paternity and the vasectomy protocol was modified by five urologists. CONCLUSION: Paternity consequent on recanalization can occur at any time after bilateral vasectomy and does not depend on the surgical procedure or criteria for sterility. Because of the major consequences of paternity after vasectomy for both the man and urologist, accurate information about the possibility of recanalization should be given to the man beforehand.

Fertilization↗
PubMed1999

Decreased no-reflow in patients with anterior myocardial infarction and pre-infarction angina.

AIMS: Pre-infarction angina is associated with better outcome after myocardial infarction. The aim of this study was to assess whether pre-infarction angina is associated with decreased no-reflow after coronary recanalization. METHODS AND RESULTS: Twenty-three patients underwent intracoronary myocardial contrast echocardiography during the acute phase of anterior myocardial infarction after successful recanalization, and before hospital discharge. Myocardial perfusion was graded semi-quantitatively in the area at risk (dyssynergic segments). Global left ventricular function was assessed by radionuclide angiography on days 8 and 42 and regional wall motion was assessed by 2D echocardiography on days 0 and 42. Fourteen patients had pre-infarction angina (angina less than 7 days before myocardial infarction) and nine did not. Baseline characteristics were similar in the two groups. The myocardial contrast echocardiography perfusion score in the area at risk after recanalization was higher in the patients with pre-infarction angina than in those without (0.72 +/- 0.19 vs 0.53 +/- 0.22, P=0.04), and the incidence of no-reflow (myocardial contrast echocardiography perfusion score < or =0.5) was lower (14% vs 56%, P=0.04). This difference persisted 8 +/- 2 days after myocardial infarction (0. 87 +/- 0.11 vs 0.69 +/- 0.26, P=0.04), and was associated with greater mid-term (day 42) improvement in left ventricular function in patients with pre-infarction angina than in those without, as assessed by changes in radionuclide left ventricular ejection fraction (+5.8 +/- 8.1% vs -3.3 +/- 4.6%, respectively;P=0.01) and by changes in regional wall motion score on 2D echocardiography (-0. 61 +/- 0.39 vs -0.24 +/- 0.17, respectively;P=0.04). CONCLUSION: Pre-infarction angina is associated with preservation of the microvasculature, reflected by reduced no-reflow. This may be a mechanism underlying greater recovery of left ventricular function in patients with pre-infarction angina.

Adult↗
PubMed2002

Assessment of the patency of microvascular venous anastomosis.

There is an absence of data on the timing of occlusion of vessels after anastomosis, and on the possible subsequent reopening (recanalization) of these vessels. This lack of information may be an important factor in the wide discrepancies found among reported patency rates for laboratory microvascular repair. In this study, a total of 300 standard microsurgical anastomoses were performed on rat femoral veins. The patency of each anastomosis was assessed at regular intervals within a 2-week study period. These results showed that the majority of venous occlusions occurred within 1 day after repair. Recanalization of the occluded vein was first seen at day 3 postoperatively. Recanalization was observed over a 2-week postoperative period with increasing frequency. The authors conclude that the optimal time to assess the technical outcome of experimental venous patency is 1 to 2 days after the repair.

Anastomosis, Surgical↗
PubMed2003

[Acute myocardial infarction after blunt polytrauma -- successful coronary intervention].

Acute myocardial infarction following blunt chest trauma is a well reported but rare finding. Especially in severely injured patients the optimal therapy of the myocardial infarction is not well established, since anticoagulants, platelet aggregation inhibitors or thrombolytics are frequently contraindicated under these conditions. We report a case of a 41-year-old man, who presented with an acute myocardial infarction in combination with a severe polytrauma (multiple rib fractures, hematothorax, pelvic bone fractures, multiple injuries of intestinal organs) after a motorcycle accident with a blunt chest and abdominal trauma. After surgical treatment of the injuries of the bones and the intestinal organs a coronary angiography was immediately performed. The left anterior descending and the circumflex coronary artery were occluded in the mid-portion of the vessels. Coronary recanalization by PTCA and the implantation of coronary stents were successful in both vessels. Despite of a non-optimal blood flow after recanalization and stenting in one vessel (LAD TIMI II flow after recanalization), and a non-optimal accompanying medical therapy, during and after intervention (intravenous heparin starting 8 hours after the coronary intervention and platelet inhibitors starting 4 days after the intervention) the coronary angiogram after 2 months documented both vessels patent without a reocclusion or a restenosis. The case report documents, that in traumatic myocardial infarctions the treating of both, the attending injuries and the myocardial ischemia, is feasible. Early coronary angiography and coronary interventions, with or without stent-implantation, are indicated, even in cases in which an adequate accompanying medical therapy with heparin and platelet inhibitors is contraindicated.

Accidents, Traffic↗
PubMed1988

[Reopening of long-segment occluded aortocoronary venous bypasses. Short- and long-term results].

Recanalization of an occluded aortocoronary vein bypass was achieved in six out of seven patients (aged 57 +/- 4 years) 3-40 months after operation and 2-16 weeks after occlusion. The recanalization was done with a specially modified catheter introduced into the stump of the occluded vessel: urokinase was infused followed by balloon dilatation. Subsequent treatment included administration of nitrates, calcium antagonists, aspirin and heparin for at least three months. Repeat coronary angiography after 3-6 months (mean 4.3 +/- 1.0 months) demonstrated vessel patency in four of the six bypasses. One of them, severely stenosed, was again successfully dilated. It is concluded that bypass recanalization can be attempted if the occlusion occurred only a few weeks previously, angiography demonstrates a bypass stump and the state of the peripheral coronary artery makes good outflow likely.

Angioplasty, Balloon↗
PubMed1985

[Long-term prognosis of acute transmural myocardial infarct after intracoronary thrombolysis treatment].

Reperfusion of the infarct vessel by a combination of intravenous and intracoronary infusion of streptokinase succeeded in 66 of 120 patients with acute transmural infarction in whom the infusion had been started less than six hours after onset of symptoms. The recanalization attempt failed in 26, and 28 were treated conventionally. Size of the infarct was determined by 201Thallium scanning before and 48 hours after the acute treatment phase. Cox analysis indicated that successful recanalization had a significantly positive effect on the long-term prognosis compared with failed thrombolysis or conventional measures. The perfusion defect (as measured by 201Thallium scan) was identical in all three groups, but after successful recanalization with streptokinase it was significantly smaller than in the other two groups. The improved long-term prognosis is presumably due to a decrease in the size of the infarct.

Aged↗
PubMed1981

Myocardial salvage after intracoronary thrombolysis with streptokinase in acute myocardial infarction.

Nine patients with acute myocardial infarction had cardiac catheterization and intracoronary infusions of streptokinase 2.3 to 4.3 hours (mean, 3.5) after the onset of symptoms. Occluded coronary arteries were opened within approximately 20 minutes in all patients, but reocclusion occurred in one patient. The immediate effect of thrombolysis on myocardial salvage was assessed with the intracoronary injection of thallium-201. Improved regional perfusion, indicating myocardial salvage after recanalization, was observed in seven of the nine patients. One patient, who had also sustained a nontransmural infarction one week before, had no change after thrombolysis. In the ninth patient, recanalization of a coronary artery was followed by reocclusion and worsening of the myocardial-perfusion defect. Intracoronary thallium-201 studies two weeks and three months after streptokinase infusion in two patients were unchanged in comparison with scintiscans performed 1.5 hours after thrombolysis. These short-term observations suggest that recanalization of obstructed coronary arteries after intracoronary thrombolysis can salvage jeopardized myocardium, However, evaluation of the long-term effects of this procedure on survival and myocardial function will require controlled clinical trials.

Aged↗
PubMed2004

Ultrasound-enhanced systemic thrombolysis for acute ischemic stroke.

BACKGROUND: Transcranial Doppler ultrasonography that is aimed at residual obstructive intracranial blood flow may help expose thrombi to tissue plasminogen activator (t-PA). Our objective was to determine whether ultrasonography can safely enhance the thrombolytic activity of t-PA. METHODS: We treated all patients who had acute ischemic stroke due to occlusion of the middle cerebral artery with intravenous t-PA within three hours after the onset of symptoms. The patients were randomly assigned to receive continuous 2-MHz transcranial Doppler ultrasonography (the target group) or placebo (the control group). The primary combined end point was complete recanalization as assessed by transcranial Doppler ultrasonography or dramatic clinical recovery. Secondary end points included recovery at 24 hours, a favorable outcome at three months, and death at three months. RESULTS: A total of 126 patients were randomly assigned to receive continuous ultrasonography (63 patients) or placebo (63 patients). Symptomatic intracerebral hemorrhage occurred in three patients in the target group and in three in the control group. Complete recanalization or dramatic clinical recovery within two hours after the administration of a t-PA bolus occurred in 31 patients in the target group (49 percent), as compared with 19 patients in the control group (30 percent; P=0.03). Twenty-four hours after treatment of the patients eligible for follow-up, 24 in the target group (44 percent) and 21 in the control group (40 percent) had dramatic clinical recovery (P=0.7). At three months, 22 of 53 patients in the target group who were eligible for follow-up analysis (42 percent) and 14 of 49 in the control group (29 percent) had favorable outcomes (as indicated by a score of 0 to 1 on the modified Rankin scale) (P=0.20). CONCLUSIONS: In patients with acute ischemic stroke, continuous transcranial Doppler augments t-PA-induced arterial recanalization, with a nonsignificant trend toward an increased rate of recovery from stroke, as compared with placebo.

Acute Disease↗
PubMed2003

Further insights into the no-reflow phenomenon after primary angioplasty in acute myocardial infarction: the role of microthromboemboli.

We tested the hypothesis that when acute coronary occlusion is caused by thrombus, part of the no-reflow phenomenon may result from spontaneous or coronary angioplasty-induced microthromboemboli, and that this phenomenon may be partly or wholly reversible. Accordingly, a thrombus was created in the left anterior descending coronary artery of 6 dogs and was labeled in vivo with (99m)Tc-DMP-444 that binds to the IIb/IIIa platelet receptor. Angioplasty was then performed to obtain thrombolysis in myocardial infarction grade-3 flow. Myocardial contrast echocardiography was performed 15 and 60 minutes after recanalization to define perfusion defect size. (99m)Tc-autoradiography and infarct size (IS) measurement were performed postmortem. An additional 5 dogs with coronary artery ligation followed by reperfusion served as control animals. These dogs also underwent myocardial contrast echocardiography and in vivo labeling with (99m)Tc-DMP-44. (99m)Tc uptake was significantly higher in the reperfused bed in dogs with thrombus compared with control dogs (2.7 +/- 0.9 vs 1.4 +/- 0.3 counts/pixel(-1)/min(-1), P =.01) indicating the presence of microthromboemboli. Perfusion defect size early (15 minutes) after recanalization was smaller than the hot spot on autoradiography and overestimated IS in dogs with thrombus. Perfusion defect size decreased with time and was closer to IS 60 minutes after recanalization. The dogs with thrombi demonstrated larger IS/risk area ratios compared with the 5 control dogs (46 +/- 6% vs 27 +/- 12%, P =.04). We conclude that part of the no-reflow phenomenon seen after angioplasty in acute coronary thrombosis is a result of microthromboemboli and is mostly reversible. No reflow late after reperfusion is a result of tissue necrosis. The thrombus burden also affects ultimate IS.

Adenosine↗
PubMed2001

Stent placement in short unilateral iliac occlusion. Technique and 24-month results.

PURPOSE: To determine the success rate and 24-month follow-up results of primary stent implantation for reconstruction of unilateral short iliac occlusion involving the aortic bifurcation. MATERIAL AND METHODS: In 90 patients attempts of percutaneous transluminal recanalization of a short unilateral occlusion of the iliac arteries were performed. In 72/90 patients, the treatment was successful. Stent implantation was performed after recanalization in all 72 patients. Pre-interventional angiography of successfully treated patients showed unilateral occlusions and contralateral stenosis in 34/72 patients. In 38/72 patients unilateral occlusion without contralateral stenosis was diagnosed. The recanalization of the common iliac artery obstructions were performed with a guidewire and excimer laser angioplasty. Totally 152 stents were used for the treatment of iliac occlusion. Standardized treadmill testing and color-coded Doppler ultrasound were performed before treatment and during the follow-up. RESULTS: In all patients, stents were placed successfully; 5 major and 7 minor complications were observed. A clinical improvement of +2 to +3 according to the American Heart Association criteria was observed in 62 and 10 patients, respectively. Angiographic control was performed after 1-30 months. The primary angiographic patency rate was 83.1%. Angiography revealed significant restenoses in 4 patients successfully treated with transluminal angioplasty, and re-occlusion in 6 patients which were referred to surgery. The patency rate after 24 months was 90.0%. CONCLUSION: Primary stent implantation is an effective treatment for short iliac obstructions and represents a true endovascular alternative to surgery.

Adult↗
PubMed2006

Treatment of portal vein tumor thrombosis of hepatoma patients with either stereotactic radiotherapy or three-dimensional conformal radiotherapy.

BACKGROUND: Patients with hepatocellular carcinoma (HCC) often have unresectable tumors. Transcatheter arterial chemoembolization (TACE) is one of the limited alternative treatments that can prolong these patients' survival. However, the presence of portal vein tumor thrombosis (PVTT) is a contraindication for TACE and, therefore, HCC patients with PVTT would be depleted of the advantage of TACE. The purpose of this study was to analyze the recanalization rate of thrombosed portal vein and treatment toxicities after stereotactic radiotherapy (SRT) or three-dimensional conformal radiotherapy (3DCRT). METHODS: From March 2002 to November 2004, 43 patients were enrolled in this prospective study. Twenty-two patients were in the SRT group and 21 in the 3DCRT group. For SRT, 3 Gy per fraction, 3 fractions per week, was given to a total dose of 45 Gy. For 3DCRT, a daily dose of 1.8 Gy, 5 fractions per week, was given to a total dose of 45 Gy. RESULTS: Of the 43 patients, 16 completed the planned radiotherapy. Eventually, 14 patients received evaluation for portal vein recanalization, 8 in the SRT and 6 in the 3DCRT group, respectively. For all patients, the crude response rate was 26%. For 14 evaluable patients, the crude response rate was 79%. It was 75% in the SRT group and 83% in the 3DCRT group (P = 0.71). The median survival time was 6.0 and 6.7 months for the SRT and 3DCRT group, respectively (P = 0.911). CONCLUSIONS: Image-based radiotherapy, either SRT or 3DCRT, can recanalize the PVTT in unresectable HCC patients. Responders also had better 1 year and 2 year survivals. A more strict patient selection criterion may maximize the potential benefits of radiotherapy for hepatoma patients with PVTT.

Adult↗
PubMed1994

Low molecular weight heparin (Fragmin) prevents early reocclusion following femoral artery thrombolysis with rt-PA in rabbits.

The purpose of this study was to evaluate the effect of low molecular weight heparin Fragmin on thrombolysis with tissue-type plasminogen activator (rt-PA) and to compare its effect to that of standard heparin. A rabbit thrombosis model was used, consisting of a blood clot produced in an isolated femoral artery segment with superimposed endothelial damage and distal stenosis. Thirty rabbits were randomized to three treatment groups with rt-PA (30 micrograms.kg-1.min-1 for 60 min and no additional therapy), rt-PA with i.v. standard heparin (200 IU.kg-1 bolus and then 70 IU.kg-1 hourly) and rt-PA with s.c. Fragmin (a single dose of 500 IU.kg-1) prior to rt-PA administration. In six of 10 rabbits given rt-PA only, recanalization was observed which was persistent in three. In eight of 10 rabbits given rt-PA with intravenous heparin, reflow was achieved, which was persistent in three. Fragmin resulted in recanalization in eight of 10 rabbits, with persistent patency in each recanalized rabbit. Reflow time was not shortened with either standard heparin or Fragmin compared with rt-PA alone (64 +/- 41, 56 +/- 18, 50 +/- 23 min respectively), (P = 0.7). Persistent reocclusion after reflow was not observed with Fragmin (0/8) but was present with both standard heparin (5/8, P = 0.03 vs Fragmin) and rt-PA alone (3/6, P = 0.05 vs Fragmin). Thus, in the femoral artery of the rabbit, Fragmin, unlike standard heparin, was found to prevent reocclusion following rt-PA thrombolysis.

Animals↗
PubMed1995

Further elevation of the ST segment during the first hour of thrombolysis. A possible early marker of reperfusion.

OBJECTIVES: To evaluate the clinical implications of early electrocardiographic changes during thrombolysis in a randomized study in patients with an acute myocardial infarction. BACKGROUND: Re-elevation of a rapidly resolving ST segment during thrombolysis is currently interpreted as a sign of re-occlusion, but a further elevation at very early stages of lytic therapy may not necessarily have the same implications. METHODS: In 214 patients with a first transmural acute myocardial infarction of < or = 4 h randomized to fibrinolytic (streptokinase group, n: 110) vs non fibrinolytic medical therapy (control group, n: 104), a standard 12 lead ECG was continuously recorded during the first 60 min and at 2, 4, 10, 16 and 24 h. Serial enzymes were measured during 72 h, and in 156 patients (73%) a coronary angiogram was performed at 10-15 days. RESULTS: Within the first 20-40 min there was an additional ST segment elevation in 50 patients (45%) from the streptokinase group and in 19 from control group (18%) (P < 0.0001) but the increment was greater in the streptokinase group (1.2 +/- 1.4 vs 0.3 +/- 1.4 mm, P < 0.0001). In the streptokinase group, the interval from onset of pain to peak creatine kinase MB was shorter in patients with additional ST segment elevation than in those without it (699 +/- 193 vs 856 +/- 299 min, P < 0.01). Moreover, in-hospital mortality tended to be lower in patients whose ST segment was elevated than in those without such elevation (2150, 4%, vs 6160, 10%). Incidence of recanalization was high but comparable in these two subsets. In recanalized patients, with or without additional ST segment elevation, the ST segment declined significantly at 1 h (-1.0 +/- 1.7, P < 0.001, vs 0.1 +/- 1.5 mm, ns). CONCLUSIONS: Additional ST segment elevation is frequently observed during the first hour of intravenous thrombolysis with streptokinase. Its' association with a subsequent early decline of ST elevation, reduced mortality, a shorter time interval to peak creatine kinase, and a high rate of late recanalization, suggest that in some patients it is one of the earliest markers of reperfusion.

Adult↗
PubMed1985

First month course of left ventricular asynergy after intracoronary thrombolysis in acute myocardial infarction. A longitudinal echocardiographic study.

Can intracoronary thrombolytic therapy (ITT) reduce the infarct size and improve regional and global left ventricular function and if so how long after recanalization does this improvement develop? 42 patients were treated with ITT, of whom 25 showed successful recanalization (group A) and 17 had persistent occlusion or reocclusion (group B). Both groups were examined five times during the first month after infarction with two-dimensional echocardiography. The 'asynergy index' improved in group A by 45% of initial pretreatment values, compared with no significant change in group B (P less than 0.005). The 'asynergy extent' improved in group A by 35%, while in group B again no change was observed (P less than 0.01). This improvement occurred slowly, significant differences being achieved by the 10th day. Entire normalization of left ventricular wall motion was observed in 5 patients (20%) from group A and in no patient from group B. We conclude that successful recanalization of the occluded coronary artery by ITT improves left ventricular wall motion in 80% of patients, with entire normalization of local function in 20% of cases. The improvement occurs slowly during the first 10 days.

Adult↗