الفهرس 
Myocardial reperfusion and no-reflowOnly 14 pages are availabe for public view
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Abstract
Background: The presence of intracoronary heavy thrombus burden during PCI plays a role in no-reflow phenomenon, distal embolization and reduced post-PCI myocardial blush. It had been postulated that intracoronary fibrinolytic administration immediately after primary PCI improves microvascular perfusion, decreases long-term infarct size, and improves LV function especially in patients having heavy thrombus burden. Accordingly, intracoronary thrombolytic was considered among the pharmacological strategies for management of high thrombus burden lesions during PCI.
Objectives: To assess the effect of low dose intracoronary streptokinase (ICSK) during primary PCI in patients presenting with acute anterior wall S-T segment elevation myocardial infarction with a definite thrombus in the left anterior descending artery on clinical, angiographic and echocardiographic outcomes.
Methods: This randomised controlled study was conducted on 100 patients at Ain Shams university hospital and National Heart Institute, who had undergone primary PCI after presenting with acute anterior wall STEMI (with no prior history of coronary angioplasty or myocardial infarction of their LADs and with a thrombus grading > thrombus grade 2). Patients were randomized to a study group (n=50), who had ICSK during primary PCI, and a control group (n=50) who had no additional therapy. Angiographic outcomes and S-T segment resolution were assessed after the PCI procedure, then 6 months follow-up of MACE and echocardiographic outcome was performed.
Results: Post-PCI indices of perfusion were significantly better in the ICSK group than in the control group, including TIMI flow grade 3 (84% vs. 58%), MBG 3 (48% vs. 28%) and cTFC (24.20 ± 4.97 vs 31.28 ± 6.70). Also, on 6 months follow-up, the SWMA index score was significantly lower in the ICSK group when compared to the control group (1.04 ± 0.08 vs 1.21 ± 0.30).
Conclusion: Administration of low dose ICSK during primary PCI in acute anterior STEMI patients with definite coronary thrombi improved coronary perfusion and caused improvement of LV function, and can be used as a good option for dealing with high thrombus burden PCI.