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Korean J Med > Volume 87(6); 2014 > Article
The Korean Journal of Medicine 2014;87(6): 728-732.
적혈구 증가증에서 거대 심혈관 혈전의 심혈관내 혈전 용해 및 혈관 성형술
이혜영, 김병옥, 변영섭, 고충원, 김정훈
인제대학교 의과대학 상계백병원 심장내과
Intracoronary Thrombolysis and Delayed Percutaneous Coronary Intervention for the Treatment of Large Coronary Thrombi in a Patient with Polycythemia Vera
Hye Young Lee, Byung Ok Kim, Young Sup Byun, Choong Won Goh, Jeong Hoon Kim
Division of Cardiology, Department of Internal Medicine, Sanggye Paik Hospital, Inje University, Seoul, Korea
Corresponding Author: Jeong Hoon Kim ,Tel: +82-2-950-1212, Fax: +82-2-950-1248, Email: jhkimmd@paik.ac.kr
Received: December 2, 2013;   Revised: March 13, 2014;   Accepted: March 28, 2014.
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: Thrombolytic therapy; Myocardial infarction; Percutaneous coronary intervention
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