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(Circulation. 1999;99:2965.)
© 1999 American Heart Association, Inc.

Images in Cardiovascular Medicine

Rapid Dissolution of Massive Intracoronary Thrombosis With Platelet Glycoprotein IIb/IIIa Receptor Inhibitor

Pairoj Rerkpattanapipat, MD; Morris N. Kotler, MD; Shahriar Yazdanfar, MD

From the Cardiac Catheterization Laboratory, Albert Einstein Medical Center, Philadelphia, Pa.

Correspondence to Shahriar Yazdanfar, MD, Cardiac Catheterization Laboratory, Albert Einstein Medical Center, 5501 Old York Rd, Philadelphia, PA 19141.

This 56-year-old man presented with unstable angina and acute pulmonary edema. He underwent cardiac catheterization, which revealed extensive thrombotic occlusion of the mid left anterior descending coronary artery (LAD), the second diagonal branch, and the second septal perforating branch (Figure 1). Recanalization of the mid-LAD with a long perfusion balloon after abciximab (Reopro) was planned. Abciximab 25 mg IV (0.25 mg/kg) was administered. Five minutes later, the first control angiogram demonstrated a complete clearance of the thrombotic material of the mid-LAD. Recanalization of the second diagonal and the second septal perforating branches with transient distal embolization to the second diagonal branch occurred (Figure 2). No balloon dilatation was necessary. Continued therapy consisted of abciximab infusion for 12 hours, aspirin, and intravenous heparin. Heparin was eventually replaced by warfarin. At 1-year follow-up, no evidence of ischemia was present.

View larger version (178K): [in this window] [in a new window]   Figure 1. LAD, occluded second diagonal branch (D), occluded second septal perforator branch (S), and coronary thrombosis (arrowheads).

View larger version (184K): [in this window] [in a new window]   Figure 2. LAD, second diagonal branch (D), and second septal perforator branch (S).

Footnotes

The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke's Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.

Circulation encourages readers to submit cardiovascular images to Dr Hugh A. McAllister, Jr, St Luke's Episcopal Hospital and Texas Heart Institute, 6720 Bertner Ave, MC1-267, Houston, TX 77030.

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This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Rerkpattanapipat, P. Articles by Yazdanfar, S. Search for Related Content PubMed PubMed Citation Articles by Rerkpattanapipat, P. Articles by Yazdanfar, S. Pubmed/NCBI databases Substance via MeSH Related Collections Anticoagulant mechanisms Chronic ischemic heart disease