PMC9354457_01
Electrocardiograms. (A) In the emergency room. (B) After intracoronary artery retrograde thrombolysis (ICART). (C) 7 days after ICART.
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The electrocardiogram showed ST elevation 0.05-0.2mV in leads II, III, and aVF (Figure 1A). The patient's chest pain symptoms were completely relieved, and the ST segment did not decrease very obviously half an hour after the operation (Figures 1B,C).
Pattern diagram of intracoronary artery retrograde thrombolysis system. (A) The right coronary plaque ruptured, leading to thrombosis. (B) The sheared balloon was placed far away from the occluded segment, and the "visual thrombolytic agent" was slowly injected into the occluded site through the sheared balloon. (C) The occluded thrombus was completely dissolved and the blood flow recovered. (D) The stent was accurately implanted into the lesion.
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Figure 2 shows the pattern of ICART combined with PPCI in the treatment of this case of acute inferior ST-segment elevation myocardial infarction.
Coronary angiogram in acute right coronary arterial occlusion. (A) The basal angiogram showed total occlusion of the right coronary artery distal segment with thrombus image. The arrow showed the occlusion. (B) The procedure of intracoronary artery retrograde thrombolysis (ICART) through the sheared balloon. The distal thrombus was gradually dissolved. The fine arrow showed the tip of the sheared balloon, and the coarse arrow indicated the thrombolytic agent with contrast agent to fill the occluded lumen. (C) After thrombolysis, the culprit lesion (arrow) in the middle of the right crown was observed. (D) A stent was implanted in the RCA to achieve revascularization.
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Mild stenosis was found in the proximal segment of the right coronary artery (RCA), and thrombosis occurred in the middle segment, resulting in vascular occlusion (Figure 3A). Then the cut balloon was inserted along the run-through guidewire to the distance of the occluded coronary artery (Figure 3B). 100,000 units of urokinase, 15 ml physiological saline, and 5 ml iopromide were mixed to form a 20 ml cocktail, which could be called a visual thrombolytic. Subsequently, 1 mL visualized thrombolytic was bolus-injected through the cut balloon, repeated every 30 s (Figure 3B). After thrombolysis with 70,000 u urokinase for 7 min, right coronary angiography showed that the coronary thrombosis disappeared completely and TIMI blood flow recovered to grade 3 (Figure 3C). Right coronary blood flow returned to TIMI grade 3 (Figure 3D).