622
441818020012657116
INTERVENČNÍ341804001071978123168215263308366420478499
A8628040010752
AKUTNÍ936804001075299157202263284
KARDIOLOGIE12418040010745103150211232295337397456477520
/18078040010732
Interv188480400107196794136163207
Akut2111804001075290139167
Kardiol.2297804001074588114162181229249264
2024;23(1):43-492581804001074487128168183227271293333351365409450477523565
/31918040010732
www.iakardiologie.cz48438040010765133201214233274312354380428447495515563613632675690730769
KAZUISTIKA341200012665137200272306365424456524597
/959200012632
CASE1012200012660131190248
REPORT1282200012662120184260325384
The34136001063071103
role46036001063374105137
of61336001063869
intracoronary6983600106155689125166200238274315357397432468
thrombolysisin118236001063071107147201237278310342375392424441482
thrombus-laden168036001063071106147201237278310338368410450482523
coronary221936001063271107148190229265301
artery:253636001063873105137173209223
a2773360010638
case282736001063274108139
report298236001063366101142178209
následek340540012155103143166216274324371
přetrvávající73254001215790139173205256305351400424447491514
ischemii,126754001212463108163213297320343364
větší165154001214897131171194
velikost186654001214897121144191245284318
infarktu220554001212378107156189236272326
a2552540012148
významné262154001214899144200248331386437
zvýšení307854001214394145184234290313
30denní3412540012151102160210266321344
mortality,3777540012183139171207256280303336386402
a4199540012149
to426854001213488
bez4376540012157108151
ohledu4548540012155111134185242297
na4866540012155103
úspěšnou499054001215594151202241296351406
PCI5417540012153111134
s5572540012140
normálním340680012155111144227275299354377460
průtokem82168001215790146179233280329412
epikardiálními1255680012150107130177226259315338386409464488571594
cévami.187068001214594142190273296317
Kazuistika:340820012358110156213239281317342393445468
Jedenapadesátiletý83682001213788146196252300357406463514554603635659682733766816
muž1681820012184139182
asijského189182001214988111135174221270326382
původu2301820012157113161216273328
byl2657820012158104129
přijat281482001215790114138186218
s3061820012140
diagnózou312982001215780128184240295337392448
STEMI.3605820012150101151231256277
Koronarografie3911820012154108141196252300333388445478526556582632
prokázala457282001215790145192242286336359407
velký500882001214898122168219
trombus525582001213466121205262318357
obturující340960012155112145200233288312335379402
proximální77096001215790144190214297345368423446
část124496001214593133166
levé143896001212474122171
koronární1636960012147101134189244292325381404
tepny206796001213483140196241
(ACS).233696001212888144194221240
Poté,2603960012154107140189209
co284096001214498
opakované2966960012155112160207261308357412462
pokusy3456960012157113160215255303
o3787960012154
manuální3869960012184132187242290313368391
aspirační428896001214887144167200248293348371
trombektomii468796001213365120204260311359395449532555579
(MAT)5293960012129107169212243
a5564960012148
balonkovou3401100012157106129184240287340388441497
angioplastiku8651100012148103159182237294318366406440463509565
nevedly14571100012156106154203260284331
k18161100012147
obnovení18911100012154112167222270319374398
průtoku2316110001215790145178233280335
krve2679110001214781132181
koronárními28881100012147101134188244292324380403487510
tepnami,3426110001213382139195243326349370
byla38241100012156103127175
provedena4027110001215790144191240298348404452
katetrizační4507110001214696128177211243267310360404459483
intrakoronární5017110001212479111144192239293326380436484516572595
trombolýza340124001213366120204261316340388433483
s8441240012139
aplikací9041240012149105129152199248293316
streptokinázy.1241124001213973106156213246300347372427475518569585
Po18471240012153106
úspěšném1974124001215595151202241297347431
zavedení2426124001214292139188245295351374
stentu2821124001214074123179211266
zůstal3108124001214398137171220243
v33721240012148
ACS34411240012161117167
difuzní3629124001215679109164208263286
reziduální3936124001213383126149206261309332387410
trombus.4367124001213466121204261316356377
Angiografické47651240012161116173196251307340388417444488535584
zhodnocení53701240012143981532103401380012155111156205261284
ACS6451380012161117167
provedené833138001215790144191241298348404454
o13091380012154
čtyři1385138001214480129163186
dny15921380012157112158
později17711380012157113155211261285308
prokázalo2100138001215790145192241285335358413
úplné25341380012155112136191242
rozpuštění2797138001213387129186241281314364419442
trombu3260138001213366121204261316
s35971380012140
průtokem3658138001215790145179233280329412
infarktovou4091138001212479108157189236272326374427483
tepnou4595138001213382139195250306
TIMI4922138001214974154179
3.5122138001215171
Diskuze:340152001236895136187245290342365
I7251520012124
když7701520012146102149194
v9851520012148
oblasti10541520012155112136184223257280
léčby1354152001212474120176223
intrakoronárního1597152001212479111144192239293326380436484516572595653708
trombu2325152001213366120204261316
neexistuje26621520012155106157204228267301356379430
zlatý3112152001214367115147197
standard,3330152001213973122177234282314370391
je3742152001212475
možné38371520012184139181236287
využít4144152001214999155198221254
kombinace44191520012147101184241265320368413462
farmakologické4901152001213078111195243289343367422479502547593642
a55641520012148
mechanické3401660012183134180235283338361406452501
léčby.861166001212474120176222239
MAT11201660012180141185
by13241660012157104
v14481660012148
případě1515166001215790114170219276326
STEMI18611660012149100150230254
neměla21351660012155106189240263311
být24661660012157104140
používána26261660012157113168211234282331386434
rutinně,3080166001213388121144199255305325
nicméně3425166001215579123206257313363
ve3808166001214897
vybraných3925166001214898156189237293338382437
případech4382166001215790113170219275326371426
může48281660012184138181231
být50791660012157103139
užitečná.5238166001215598122155204250305353374
Katetrizační3401800012154103136185219251275318367412467490
intrakoronární851180001212378111143192238292325380435483516572595
trombolýza1466180001213366120204261317341388433483
může19691800012184138181231
být22211800012156103139
bezpečnou23811800012157107151208259304360415470
a28711800012149
účinnou29401800012155100123178233288344
alternativou3304180001214872105154187243291323346394448504
reperfuzní3828180001213383140191224256312355410433
strategie,4282180001213973106154187236293316366386
pokud46881800012157113161216273
MAT49811800012180142185
samotnou5187180001213988171227259315370425
nedosáhneme3401940012155106163218258307362417468551602
dostatečného9631940012156111151184233266315361416466522577
průtoku1561194001215790145179233280335
krve1917194001214781133182
infarktovou2120194001212378107156189236272326373427482
tepnou2623194001213383140196251306
(IRA).2950194001212951105168196214
Závěr:3402080012357109158208244269
Řešení6372080012154104143194249272
intrakoronárního937208001212479111144192239293326380436484516572595653708
trombu1673208001213365120204260316
během20172080012157108163214297
PCI23422080012154112134
je2505208001212474
i26072080012124
nadále26592080012155103160208231282
terapeutickou2969208001213382115164220271327360383427474528583
výzvou,3580208001214899144195249304325
přičemž3933208001215790113158207290333
lepších4294208001212474131170194238293
výsledků4615208001214899139162212270316372
lze5015208001212366116
dosáhnout51592080012156112151200255310365421454
pomocí3402220012157113196252297320
agresivního,6812220012149104137187226249297354377434489508
individuálního1211222001212378135158206230287341390413468491548603
přístupu1836222001215789113152186241297353
šitého221022200121406396145201256
na24872220012156104
míru.26122220012183106139194215
Klíčová340239001246189116160217268320
slova:676239001244371128179231256
intrakoronární949239001212377109141188234287319372427474506561583
streptokináza,1549239001213972104153209241294341365419466508557578
manuální21442390012182129184237284307361384
aspirační2545239001214786141164195243287341363
trombektomie2925239001213365118201256306353388441523546595
(MAT),35372390012128105166208238256
intrakoronární3810239001212378109141188234287319373427474506561583
trombus,4410239001213365118201256311349370
primární4797239001215688111193240271326349
perkutánní51632390012156106138184239271319373427450
koronární3402530012147101134188244292324380403
intervence764253001212479111161194245294350395444
(PCI),1229253001212881138161189207
infarkt1457253001212479108157189236272
myokardu17512530012181123175220271303354406
s21762530012137
elevacemi2231253001214568113159209252295376398
úseku2648253001215289133179231
ST2897253001214794
(STEMI).3012253001212875126176256280307326
Introduction3402970014732101143186254325394448493524592661
Intracoronary480314001092273103133178219268299349401445475521
thrombus1027314001093081111161238290341378
remains1431314001092975152196218269305
one17623140010950101147
of1935314001095077
the340328001093080126
main4923280010975119141191
enemies709328001094596142218239285321
of1056328001095076
the1158328001093080126
interventional1310328001092172101146176223268319349370420471515536
cardiologist.1872328001094185115340342001095275128152204258281319352373
Approximately7473420010957111166198250293317395441473520544589
10%1371342001094792168
of1573342001095179
patients1687342001095299131154202255286325
undergoing3403560010951103157205236289341364416469
primary838356001095384107185231262310
PCI11773560010949104126
experience1332356001094691145194225248296348391438
distal1798356001095375113145191214
embolization3403700010944119169218240260298342371391440489
of845370001094874
the934370001093079123
thrombus,1072370001093079107156230280329364383
resulting1470370001092973108156177206227276325
in1810370001092170
coronary1895370001094088340384001092979129173203248
microvascular606384001097596137166216259303338379429450494523
obstruction11473840010949101137168197248289321342392442
and1607384001094393145
decreased1769384001095197138168213340398001094379125177
myocardial5393980010975117166207251281332353397418
tissue98039800109295086122171217
perfusion.1219398001095198128157208243264314365384
This1626398001094495117152
could1801398001094089139160211
result340412001093075112162184214
in580412001092172
continued678412001094090141171192243293339392
ischemia,109641200109215799149195272293337357
more14794120010976126157203
extensive1707412001094689122168219255276340426001094489
infarct45542600109217198143173214246
size,72742600109365797142161
and914426001094494146
a10864260010944
significantly1156426001093657108159180207232273317368398420463
increased1645426001092172113143189233269315368
30-day340440001094692124177221262
mortality6274400010976126156188233254275305351
(hazard1003440001092576119159204233284
ratio1313440001092973103124174
[HR]1512440001092685134159
3.0,1696440001094665111130
95%1851440001094692161
confidence340454001094191142169194246292344385431
interval797454001092172102148179226271293
[CI]111645400109267799125
1.19–7.58;1267454001094762104146195238249298345364
P16574540010948
=17324540010954
0.02),1812454001094766114159183201
despite340468001095094129178199228271
a6264680010943
successful683468001093583123161204239273299348369
PCI1067468001094798118
with1199468001096586115164
normal1377468001094998127200242263
epicardial1655468001094494115154197225275295337357
vascular340482001094387123164214235279308
flow667482001092650100166
(1).85248200109256887104
The975482001094596141
MAT11354820010973128168
procedure1321482001095282131172217269318348393
is1733482001092157
often1808482001095076109154205
performed3404960010953101132163215246325372426
as793496001094582
a9024960010945
first-line97449600109275283121153180204226278326
measure13274960010977125170207259290337
to1691496001093081
reduce1799496001093178132183340510001094085
these449510001093080125161207
side680510001093657108154
effects,858510001094572102147189221258277
although115951000109436595145195245296346
its152951000109215188
beneficial1641510001095198148194221245285307350371
effect34052400109447099143183214
during569524001095098126147195245
PCI828524001094798118
is961524001092155
still103152400109356585105125
debated1171524001095094144187216259309
(2).149552400109256891107
When16175240010975124168217
MAT18495240010971125163
fails34053800109266990110145
to500538001092977
achieve592538001094382131151196238281
adequate889538001094292137188236279307351
coronary1255538001094087116165214256285330
blood1600538001095071120169220
flow,183553800109264998163178
intracoronary340552001092171101130174215264294343394437467513
thrombolysis878552001092979109158234286336358401437458494
using1397552001094985106156207
a16295520010943
catheter1697552001094185115165210241286315
may3405660010975119160
be516566001095298
a6305660010943
safe689566001093681107153
and858566001094393145
effective1019566001094572102147189221242286330
alternative136556600109446595140170221264294315359403
reperfusion1784566001093075127173203340580001092676112132182232
strategy58858000109356695139168212264307
for910580001092676106
IRA1031580001092270127
complicated1174580001094088163214236257297341370414466
by1656580001095192
a17645800010943
large182358000109216494144189
thrombus340594001093081111162238291342378
(3).74459400109267295113
We8835940010977121
report1030594001093076129180211244
a13015940010943
case1371594001094085122168
of1566594001095077
coronary1669594001094190121171223267297344
reperfusion340608001092975126173203232283318339389440
via800608001094365109
a9296080010943
combination993608001094089164216238288331361382432482
of1496608001094976
MAT,15926080010972128167181
balloon17946080010951951171381883406220010950102
angioplasty,468622001094495147169220273296341377409455470
and965622001094495148
intracoronary1139622001092172103133178220270301351403447478525
catheter1690622001094186116168214246291322
thrombolysis340636001093080109159234286336358401437458494
in850636001092171
a9386360010943
STEMI-induced997636001094591136208231260283333384434475519571
thrombotic1584636001093080110159235286337367388428
occlusion340650001094991130152201237258308358
in717650001092272
the808650001092979125
RCA.9526500010949101158179
Case3406750014771132182245
Presentation6126750014767110172223286355397459501532600669
A4806920010955
51-year-old560692001094688113156201244274299351373425
Asian1009692001095592113157207
man12406920010975119169
presents1434692001095181126162208258288325
to1783692001093079
the1887692001093080125
emergency3407060010946125173205258306358401448
room819706001093082135214
with1063706001096891123176
sudden1269706001093788142196244296
chest1596706001094194142179212
pain18387060010953100122175
that340720001093183128159
has527720001095197134
lasted688720001092268105137184238
for953720001092779111
111091720001094887
hours,12057200010952104156187226246
accompanied1479720001094487128179257311357409432479533
by340734001095296
cold462734001094191114167
sweat6557340010937106152197227
and909734001094496148
nausea.1084734001095196146183230275295
The1406734001094698145
patient1578734001095297128150197249279
is1884734001092158
a19687340010945
two-pack340748001093098148178231275316358
daily720748001095195116137180
smoker9237480010935110160203248278
with1223748001096688118168
high1414748001094971121171
blood1608748001095173123174225
pressure1856748001095181126340762001093671121150195
without556762001096788119168218269299
any876762001094393135
history1032762001095071106137186216262
of1315762001094976
medication14127620010975121173194234279308329379430
use.1863762001094985131149
The340776001094495140
patient496776001095195124145190240269
also78177600109436499149
consumes946776001094088138173222297342378
coffee1339776001094189115144190235
and1590776001094393144
energy1750776001094494140169219262
drinks2140300001095180102152194233
every2394300001094588133163208
day2623300001095195136
as2780300001094479
a28803000010944
public29453000010951101153175196236
transport3202300001093060104154189241291321354
driver.3577300001095180102146190220236
At2140314001095583
the2238314001093079124
first237831400109265079115145
medical25393140010974120171192232275296
contact,2851314001094088138167211251283302
the3168314001093079124
patient3308314001095194123144189239268
appeared35923140010943931451902140328001094373118169
fully232532800109267798119162
conscious,2503328001094089139174215236285335371390
GCS29093280010958110155
456,3080328001094691137156
blood3252328001095172122172224
pressure3492328001095181126162197246276321
of2140342001095178
140/902245342001094790139170217266
mmHg,25383420010976154215267287
a28523420010944
heart2923342001095198143174208
rate3158342001093075106152
of3337342001095078
1003442342001094791140
bpm,36093420010952106184204
and2140356001094393145
a23013560010943
respiratory2360356001093075111162183213257286335365411
rate2787356001093073103148
of2951356001094976
243043356001094690
breaths/min,3149356001095181126170200250285316389411461480
with3645356001096688118168
the2140370001093079124
remainder2280370001092974149192213262313358388
of2683370001094976
physical27743700010951101142178198238282303
examination3093370001094587130205226275318347368417467
within3576370001096687117166187237
normal2140384001094998127201244265
limits.2420384001092141115135164200219
The2654384001094494139
ECG2808384001094494149
showed2972384001093584133197241292
a32793840010943
sinus3337384001093555104152187
rhythm3539384001092978119151200273
of2140398001094976
1002238398001094689137
beats/min2397398001095197141171208239312333383
with2803398001096688118168
ST2993398001094490
segment3105398001093682133208254305334
elevation3461398001094567113156200230251301351
in2140412001092171
leads2227412001092166109160196
II,243941200109214362
III,25174120010921436584
AVF,26174120010955101146156
and2789412001094493144
V3R–V6R2949412001095097144190239284332
(Fig.329741200109266889139158
1).347141200109466582
Serum3569412001094490119169244
creatinine2140426001094171117161192213264286337384
was25504260010967111148
1.12724426001094762104
mg/dL,28544260010976128160208252272
serum3152426001093783114165241
troponin-I3419426001093161111164215267289340369393
was21404400010967112148
3.02314440001094766113
ng/mL,24544400010950102134209253273
random2753440001093075126178229306
blood3085440001095275125177230
glucose3341440001095173123165214251297
was36654400010967111148
2112140454001094790129
mg/dL,22954540010977129161210254275
and2596454001094495148
hepatitis2770454001095198151196227249279301338
B31344540010950
was32104540010968113149
reactive.3385454001093077121163196218263309328
In3739454001092273
this2140468001093079100135
antiplatelet-naive2291468001094493122143194216259289333355400430456506550571614658
patient,2965468001095195124145191241270289
a32704680010943
loading3329468001092171115166187236287
dose36324680010950100135180
of3940300001094976
3004036300001094692140
mg41973000010975126
aspirin4343300001094379130152181203253
and4616300001094494145
1804781300001094688136
mg49373000010975126
ticagrelor508330000109305192136186216261283333363
was54673000010966110145
administered,3940314001094395170191241263298329374404449501520
followed447931400109267698119169235280332
by4830314001095194
primary4943314001095181102178221251297
PCI.52593140010947100121141
Coronary40803280010954104135186239284315362
angiography4469328001094496149171223276307352406458501
showed4997328001093688140208255308
normal53323280010951103134213258280
appearance3940342001094395147193237266310360401446
of4410342001094976
the4510342001092979125
left465934200109216794127
main48103420010975119140190
coronary5024342001094189119169219263293338
artery5386342001094473106151181226
(LMCA),3940356001092668142195252277295
left426035600109226895129
anterior4414356001094494124169200221272302
descending4742356001095197133174219270322344394445
(LAD),5213356001092668126186210228
and5466356001094495146
left394037000109227098133
circumflex410137000109416495137188267295320368412
(LCx)4541370001092770123169196
(Fig.476537000109267193146166
2a),4959370001094893118137
whereas51243700010968120168200247293330
the5482370001093083130
RCA39403840010948101158
was41233840010967111146
completely4295384001094089165216238284314359381424
occluded4745384001094991130152201253299351
by5121384001095193
thrombus5240384001093080109159235286337372
proximally3940398001095282132174196272317339360404
(Fig.437039800109266990142161
2b).4557398001094798122139
The4722398001094597143
PCI48913980010949102123
procedure5040398001095283133175220272323353399
was54653980010967111147
followed394041200109267698119169235280332
by4295412001095193
an4411412001094393
intravenous4527412001092171101130174217261312362412447
(IV)499741200109264797126
bolus51454120010952102124174209
of5377412001095076
1005476412001094688137
u/kg3940426001094981124173
BW41294260010948123
unfractionated4268426001094999125155199239271292341391434464508559
heparin4843426001095095146190219241290
(7,000514942600109257180127174222
units),5387426001094999120149186208225
without3940440001096789120171222273304
the4270440001093182128
addition4424440001094497149171202223274326
of4776440001095077
GP48804400010959108
IIb/IIIa501444000109224597128151174196241
inhibitor5281440001092172124145198220251301331
therapy3940454001093080126155199251293
(not4253454001092573123153
available4426454001094385129150172215267289334
at4780454001094473
the4873454001093080126
time5018454001093051126172
of5210454001094976
the5306454001093080125
procedure).54514540010951811313940468001094085137186216261284302
Wire4266468001097698128173
crossing4463468001094170120156191212262313
was48004680010967111146
performed4971468001095197127156206236312358410
using5405468001095086107157208
Fig2140491001124771125
1.2283491001125070
Electrocardiogram239949100107405795133160186230268312338381399445491516559630
at3045491001074672
admission3133491001074590162180209239256302348