734
4556558020012657115
www.iakardiologie.cz3408040010765133201214233274312354380428447495515563613632675690730769
/27308040010732
Interv280780400107196793136162206
Akut3033804001075391139167
Kardiol.3220804001074587114162180228248264
2024;23(1):43-493504804001074487128168182227271293333350365408449476523565
/41148040010731
INTERVENČNÍ4191804001071978123168215263308366420478499
A47128040010752
AKUTNÍ4786804001075399158202263284
KARDIOLOGIE50918040010745103150211232295337397456477521
KAZUISTIKA4286200012665137200272306365424456524597
/4904200012632
CASE4957200012660131190248
REPORT5227200012662120184260325384
The276236001063071103
role288136001063374105137
of303436001063869
intracoronary31193600106155689125166200238274315357397432468
thrombolysisin360336001063071107147201237278310342375392424441482
thrombus-laden410136001063071106147201237278310338368410450482523
coronary464036001063271107148190229265301
artery:495736001063873105137173209223
a5194360010638
case524836001063274108139
report540336001063366101142178209
a3404960010944
0.014"410496001094766114158200231
high-torque667496001095173124176206237287318369420467
hydrophilic1160496001095193145175225278330352374396437
guidewire16234960010951102124176223291313343389
(Whisper3405100010926104155176212263309339
MS,7055100010972117136
Abbot,8665100010955107159210239259
Minneapolis,1150510001097395145195241284336387409430465485
USA)16605100010958102157182
and1867510001094494145
successfully340524001093583123161204239274300350370391432
penetrated787524001095196145189219247290319362413
the1215524001092978122
lesion1352524001092165100120169218
distal1585524001095070105135178198
to1798524001092977
the1890524001092978122
RCA;3405380010948101158177
however,5385380010950100166211254299329344
antegrade903538001094393123167219249293344390
flow1314538001092650100166
was15015380010966110146
obtained16685380010949101131176197247293344
on3405520010949100
angiography,464552001094393144165215266296340391442484498
with986552001096688118168
grade1178552001095080124175221
014225520010946
TIMI1492552001094567140162
flow1678552001092650100166
and1868552001094393144
grade340566001095080124175221
55805660010946
TIMI645566001094568140163
thrombus827566001092979109158234286336371
quantification.12185660010950100143194223244271295336380409430480531550
MAT4805800010972128168
was6735800010966110146
performed844580001095198128157207237313359411
using1280580001095085106157207
a15135800010943
6-Fr1582580001094677123150
aspiration1758580001094379130152181225340594001093051101151
catheter515594001094084114164209240285315
(Capturer,853594001092576120171201251281326356371
iVascular,1247594001092172114150190240262305335350
Barcelona,1620594001094993122163207229279330373393
Italy),34060800109225296117160185202
and561608001094393144
a7246080010943
red786608001092975127
and931608001094494145
white10956080010966116138168213
thrombus1326608001093080109159235286336372
was17176080010966110145
obtained1881608001094910134062200109307495145191243
(Fig.60562200109266990140159
2c);787622001094685109127
however,9366220010950100166211254298328343
there1301622001093080126156201
was15246220010966110146
no16926220010950100
antegrade1814622001094494123168340636001095180125176222
flow588636001092651101167
from781636001092657107183
the990636001093080126
proximal1142636001095181131172194270314336
RCA15036360010949102159
(Fig.168763600109266990141161
2d).1873636001094796122140
To340650001094589
compress451650001094189165216246292328363
the837650001092979125
lesion,984650001092267103124174225244
a12506500010943
1.51316650001094661109
×14486500010953
151524650001094686
mm16336500010975150
semi­1805650001093682157179207
-compliant340664001092871119195246268289333383412
balloon772664001095196117138188239289
(Sapphire1081664001092668112164215266287317362
II,146366400109214363
OrbusNeich,1545664001096293145195231290336358398448467
Netherlands)3406780010959105136186231261283327377428464487
was8446780010967111146
inflated100867800109217197121165195239291
to1317678001093079
161414678001094688
atmospheres1520678001094373148198233285335381411456492
(atm)34069200109266696171195
proximal555692001095282131172194269313334
to910692001093079
distal1010692001095172107138183204
to1235692001093079
the1335692001093079125
RCA,14816920010949101158179
followed168069200109277799120170236281333
by340706001095193
administration456706001094395170191241263298329359403432453503554
of1033706001094976
0.51131706001094765114
mg12677060010975126
atropine1416706001094473103152204226276322
sulfate1760706001093685107134178208252
as340720001094582
the449720001093183130
patient606720001095399130153200253284
developed9177200010952100145191214267320369423
bradycardia1367720001095384130183229270316347400423468
and1862720001094597151
hypotension.340734001094989139188217260309343363411460478
The832734001094494138
procedure984734001095079127167210260308336380
was13787340010965107141
continued1533734001094087136164184232280324375
by1922734001095091
dilating34074800109507192135165185235285
the641748001092979124
lesion781748001092166102122172222
using1018748001095085106155205
a12397480010943
2.251298748001094665113159
×14727480010954
121542748001094585
mm16437480010974149
semi­1808748001093580155176204
-compliant340762001092871119195246268289333383412
balloon772762001095196117138188239289
(Sapphire1081762001092668112164215266287317362
II,146376200109214363
OrbusNeich,1545762001096293145195231290336358398448467
Netherlands)3407760010960107138189235266288332383436472495
to861776001093180
15968776001094688
atm1082776001094474150
midway1258776001097698150218263305
to1589776001093080
the1695776001093081128
proximal18497760010952821332140496001094264139183204
RCA.23704960010948101158179
Angiography25754960010955105156178228279309353405456497
after3098496001094370103148178
balloon3301496001095296118139189240291
angioplasty36174960010944941451662140510001094999121163198228272
showed2427510001093584133198242292
an2735510001094291
increase2841510001092170110139183226260305
in3161510001092170
coronary3246510001094087117165214257286330
blood3591510001095172121170221
flow214052400109265099164
from2319524001092656105179
TIMI2514524001094466138160
flow268952400109265099164
grade2868524001095079123173218
031025240010945
to3163524001092978
232565240010946
with3317524001096687117166
a34985240010943
diffuse355752400109507197126176211256
thrombus2140538001093080110159235287337373
along2538538001094465116166217
the2781538001093080126
RCA29325380010949101158
(Fig.311653800109256989140159
2e).3301538001094690114131
A34575380010955
second3538538001093682123172223274
MAT21405520010972128167
was23315520010967111146
performed2501552001095198128157207237313358410
in2935552001092171
an3030552001094494
attempt3148552001094373105150225277307
to3479552001093079
remove35815520010930751512012140566001094388
the2251566001093080125
remaining2399566001093075150194215265286336387
thrombus,2809566001093080110159235286336372391
only32235660010950100122165
to3411566001093079
find3513566001092650100151
the3687566001093080126
aspiration2140580001094379130152181225255276326376
catheter2534580001094084114164209240285315
blocked2866580001095173123164207251303
by3186580001095193
a32965800010944
clot3357580001094061111141
(Fig.351658000109256889140159
2f).3692580001094673103120
Due22805940010960110156
to2453594001093079
a25495940010943
diffuse260959400109517299129179215261
thrombus2887594001092979109158234285336371
in3275594001092171
the3363594001093080126
RCA,35065940010948101157178
we37015940010966111
decided2140608001095196138159210256308
to2471608001093079
perform2574608001095197127156206236312
intracoronary2910608001092171100130174215263293343393437466512
thrombolysis.34466080010929791091582342853362140622001092267105127164185
Streptokinase2352622001094676107155209240291336360412458495543
250,0002923622001094795143163212262312
units32626220010951104126158196
(Fibrion,348662200109277293147179201253306326
Lyocontract,2140636001094484136179231283315346392435469490
Lisenburg,2662636001094466104152205259311343396416
Germany)31106360010960109140219265318361387
diluted352963600109527598150182229283
in2140650001092173
16.72239650001094790110157
mL24236500010976120
normal25706500010950102133210255277
saline2873650001093782104126177224
was31246500010967112149
administered3299650001094497174196247269306337383414460514
slowly2140664001093657107173195238
over2397664001094992137167
525836640010946
minutes2648664001097596146196226271307
using2974664001094985106156207
a32006640010943
4.03262664001094665112
6-Fr3393664001094677123151
Judkin3563664001093383134177199249
Right2140678001094870120170200
guiding2356678001095099120172193242293
catheter2665678001094084114164209240284314
(Launcher,2995678001092567112161211252302347377392
Medtronic,34036780010972118169199229278329350390409
Minneapolis,2140692001097598150203251297351404428450488509
USA),26816920010960106163189208
followed2921692001092779103126178247294349
by3302692001095297
dilatation343169200109527598144175222253276328381
with2140706001096891123174
a23427060010944
3.02413706001094867116
×25567060010955
202638706001094795
mm27607060010977155
semi-compliant2942706001093784163185215260311389442465488533585616
balloon358570600109539912114419621407200010951104
(Sapphire2278720001092772118172227280303335382
II,269572000109224667
OrbusNeich,2796720001096496151204241304352376419471492
Hoevelaken,33227200010961114163208255279325370417470491
Netherlands)21407340010959105136186232262284328378429465488
up26537340010950102
to2780734001093079
152884734001094787
atm2997734001094373148
for3171734001092676106
manipulating33037340010975119169190242292313357387408458509
the2140748001093079124
partially2280748001095195124156177220241262305
lysed2600748001092164100145196
thrombus;2812748001093079108157232283333368386
however,3213748001095099165209252296326340
angiography35697480010943931431642132140762001095079123174224265
showed2421762001093585134200244296
disappointing2732762001095172107151202253303324374403424473524
results.3272762001092974109158179209245265
We35527620010976119
decided36877620010950952140776001094061111156208
to2363776001093078
continue2457776001094088138167187237286331
intracoronary2803776001092171100129172212261290339389432461506
thrombolysis3325776001092979108156231282332354396432452487
using394062001095085106156207
the416462001093080126
same430662001093681156202
amount4525620010943118168218269298
of484062001094976
streptokinase,49336200109366696141193223272315338388431467513531
but5481620010951101131
there394076001093080126155201
was4161760010967110146
almost432876001094364140190225256
no4605760010950100
difference47257600109517299129174204249300341385
in513176001092171
antegrade522376001094393123167219248292344389
flow394090001092752103171
in413790001092273
the423790001093081128
distal439290001095274110142188210
portion4628900010953105136169191242294
of494990001095078
the505390001093182129
RCA.5209900010949103161183
After541890001095784118164195
repeated3940104001092975127173217246291343
intracoronary4309104001092171100130174215264294344394438468513
thrombolysis4848104001093080109159235286337359402438459495
five536810400109265094139
times553210400109305139401180010975121157
with4122118001096688118168
a43151180010944
total4384118001093079109153175
of4584118001094976
1,500,0004685118001094661109155203221268316364
units50741180010950100121151188
of5288118001094976
streptokinase5389118001093666961411933940132001093079122144194238274319
over4279132001094992137167
304466132001094692
minutes,4577132001097597147196227271307327
an4923132001094494
antegrade5036132001094494123168220249293345390
flow5446132001092650100166
improvement3940146001092196148178227270315390436486516
to4478146001093079
TIMI4580146001094567140162
flow4765146001092650100166
grade4954146001095080124175221
351971460010946
was52661460010966110146
seen5434146001093682128178
with3940160001096688118168
the4129160001093080125
thrombus4275160001093080109159235286336372
still466816000109356687109130
in4819160001092171
place4910160001095274117158202
(Fig.513316000109266990140159
2g).5313160001094695120137
The5470160001094596142
proximal3940174001095181131172194269312334
to4297174001093079
the4400174001092979125
middle4548174001097597148199221267
of4838174001094976
the4937174001093080126
RCA50861740010949101158
was52671740010967110146
then5436174001093080126176
stented3940188001093667111162191236288
using4250188001094985106156207
a44791880010943
3.54544188001094665113
×46791880010954
364755188001094692
mm48681880010976151
sirolimus504118800109355686135157178253303339
drug­5402188001095080130181210
-eluting394020200109287698148179200251302
stent4268202001093667112163193
(DES)4487202001092686131177202
(X-limus,4715202001092679104127149224275311330
Cardionovum,5071202001095397127178200250301352395446522541
Bonn,39402160010950102154205225
Germany)41922160010959107138216261313355381
developed4599216001095299144190213264318365419
to5044216001093181
165152216001094791
atm5269216001094575153
(Fig.544821600109267192145164
2h).3940230001094797121138
After4104230001095683117162193
undergoing43232300010951102154201231283334356407459
the4808230001093081128
procedure,4962230001095283133175221274324355401420
there5408230001093081128158204
were39402440010967112142188
no41542440010950100
complaints4280244001094090166218240284305356386423
of4729244001094976
chest4831244001094091137173204
pain5061244001095296118168
anymore,5255244001094394136212263293339357
but39402580010952103133
the4099258001093181128
patient4253258001095297127148195246276
began4555258001095299151195246
to4827258001093080
experience4933258001094689142189219241288339380426
hypotension;53852580010950921451973940272001093076127164185236288306
therefore,4272272001093081128158205232283314360379
he4677272001095197
was48012720010967112148
given4975272001095173118163215
dopamine52162720010951102155200277299350396
(53940286001092569
mcg/kg/min)40242860010974114163194237285316388409458481
and4520286001094392143
norepinephrine4678286001094998128172223244293338388438467488537582
(0.1527528600109267088128
mcg/54182860010975115163194
kg/min)3940300001094292124197218268291
with4250300001096688118168
a44373000010943
target4499300001093074104154200230
systolic4748300001093679115146195217238279
blood5046300001095173123173225
pressure5290300001095181127162198247277322
of3940314001094976
>40353140010954
1404108314001094687135
mmHg.42623140010975150210261280
With4080328001097698128178
a42793280010944
residual4344328001092975111132183232276297
thrombus4663328001092979109158234286336371
after5056328001094369102147177
stent5254328001093667112162192
placement,54673280010951731163940342001094186162208259289309
the4275342001093080126
risk442734200109305288131
of4584342001094976
stent4686342001093667113164193
thrombosis4905342001093081111161237289340376398434
is5364342001092258
very5447342001094489119166
high.3940356001095071122172191
After4151356001095581114159188
considering4359356001094089139175196247293323344394445
the4824356001092979125
low4968356001092272138
bleeding5125356001095173119165217238288339
risk548435600109295186128
(PRECISE-DAPT3940370001092674123169221243288333361424478527574
score4540370001093677127158204
=47703700010954
10),4850370001094790115133
the5009370001093081127
patient5162370001095297127149195247277
was54653700010967111148
given3940384001095072115160210
triple417038400109305981132154200
therapy:4389384001093080126156200251293313
aspirin4721384001094379130152181203253
1004993384001094689137
mg51493840010975126
every5295384001094588133162208
245522384001094791
hours39403980010950101152182219
and4185398001094394146
ticagrelor435739800109305193137189219264287337368
904751398001094694
mg48713980010976127
every5024398001094689135165211
125261398001094687
hours,53743980010950101152182219238
followed3940412001092779102125177245292346
by4313412001095396
warfarin44374120010968113144175221253275327
247914120010948
mg48664120010977130
every5023412001094792138170217
245267412001094893
hours53874120010952104156187225
one39404260010950102148
day4114426001095296139
after4279426001094471105150181
PCI.44864260010948102124144
During46564260010961112143165216267
the4950426001093081127
three5104426001093081111157204
days5334426001095296138175
of5535426001095078
intensive3940440001092172102147198234255299344
care4310440001094185115161
after4497440001094370104149179
primary4702440001095282104180224254300
PCI,50284400010948101122142
there5196440001093080127157203
were54244400010967112143188
no39404540010950100
complaints4060454001094189165217239282303353383420
of4500454001095076
chest4597454001094090136172203
pain4820454001095195117167
or5007454001095080
signs5107454001093657107158193
of5321454001094976
bleeding;54174540010951731191653940468001095172121172190
this4146468001092979100135
may42974680010975118160
be4473468001095197
related458646800109297496139168213264
to4866468001093079
the4961468001092979125
absence5102468001094394129175225266310
of5428468001094976
an5520468001094393
increase3940482001092171111141186229265310
in4266482001092171
the4353482001093079125
INR4494482001092181129
value4639482001094387108158203
in4858482001092171
the4945482001093079125
lab5086482001092164116
results.5217482001093075110160181211247267
On55004820010962112
evaluation3940496001094588131153202245275295345395
angiography4351496001094393144165214265295338389440481
performed4848496001095197126155205235310356407
four5271496001092676126155
days5442496001095094135171
after3940510001094369102146176
primary4132510001095180102176219249294
PCI,4442510001094799120139
complete4597510001094088163214236281311356
dissolution4968510001095172107142192214263293313363413
of5397510001094975
the5488510001092979124
thrombus3940524001093081112162239292343379
was43465240010967112148
seen4520524001093783131182
with4728524001096890121172
TIMI4926524001094569143166
flow5118524001092651102169
grade5314524001095181126179225
355655240010947
on39405380010950102
the4068538001093182129
RCA.42235380010949103161183
Subsequently,4432538001094596148185232285336383434465486531546
the5004538001093182129
patient5159538001095297128150196248278
was54645380010967112148
discharged3940552001095275112155207252283336384438
six4405552001093759104
days4536552001095298141179
post-primary47425520010953106143176203257289312390435466514
PCI52845520010949104126
with5438552001096891122174
dual39405660010951100143164
antiplatelet4120566001094493123143194216259289333355400431
therapy4566566001093080125155199250291
(aspirin4873566001092666102153174203225274
and5163566001094393144
ticagrelor)5323566001093051911351852152603940580001092171101125
for4086580001092776106
more42135800010975126156201
than4435580001093079123173
124629580001094686
months.47365800010975126176206256291311
There5068580001094495141171216
were53055800010966111141187
no5513580001095099
complaints3940594001094089165216238282303353382419
of4382594001094976
chest4481594001094090136172203
pain4706594001095296117167
or4896594001094979
bleeding4998594001095173119165217238288339
during53605940010951100130152202252
the3940608001093079124
patient’s4080608001095195124145190240269291323
follow-up441960800109267597118167233261312363
visits4797608001094365100121151187
on5000608001094999
days5115608001095093134170
353006080010946
and5362608001094393144
305521608001094692
after3940622001094370103148178
being4137622001095197119169220
discharged4376622001095072107148198242271322367419
from4814622001092757107182
hospital.50156220010950100136187209239283305324
Discussion39406470014782114164219287338388419487556
Intracoronary3940675001432589125160215269331367429494548583640
Thrombus46096750014356122157219318384448492
The40806920010946100149
pathophysiology42706920010953100133186239294348392431454507531584639685
underlying49976920010951104159207240264310334387441
the5480692001093083132
development3940706001095299143189212263316393440492523
of4489706001095078
intracoronary4593706001092273104134179221271302353405450480527
thrombus5146706001093182113163241294345382
is5554706001092258
Virchow’s3940720001095073102142192242308329362
triad,432672000109306081125176196
triggered454672000109305981132182228258303355
by4926720001095193
rupture5043720001093080131162211241286
or5354720001094979
erosion54577200010945751253940734001093657107157
of4116734001095076
an4211734001094494
atherosclerotic4324734001094373123169199248284325346392422471501522563
plaque4906734001095173117168218263
resulting5189734001092974110159181211232282333
in5541734001092171
thrombus3940748001092978106154227277326360
formation4315748001092574103176218247267315364
in4694748001092069
the4777748001093078122
epicardial4914748001094494115154197225274295337357
coronary5286748001093986115163212254282326
arteries.3940762001094372105149179200245281300
In4256762001092171
approximately4343762001094394145175224265287361404434478500542
70%4901762001094690162
of5079762001094975
cases,5170762001094084119165200219
acute5405762001094383133163207
thrombus3940776001092978106154227277325360
formation4314776001092574102176218246266315363
occurs4691776001094989127175203238
after4943776001094368100143172
atheroscleroFig512977600109427111916319224027431333437840645434061001124770123
2.47861001124974
Coronary59662001074890116159205249274313
Angiography.92262001074894138156201246271313358404439452
(a)13876200107236687
LMCA,1487620010737104152202219
LAD,171962001073787142157
and188962001074490135
LCx203762001073781119
appear216962001074489135173217242
normal.242462001074691116187231249265
(b)27026200107236889
Total280462001073979104147165
occlusion298262001074482117135179208225270316
of331162001074467
the339162001072671109
proximal351362001074570113149166237281299
part34073001074591117145
of50673001074568
the59573001072773111
RCA72773001074492142
with89073001076381106152
TIMI106473001073958126145
flow12307300107234388151
grade140273001074571113159197
0.162073001074258
(c)16997300107245982
MAT1802730010768116150
succeeded197473001073175112148184223268306352
in234773001071965
obtaining243373001074591116159178224242288333
a2787730010745
red285373001072663109
and298373001074591136
white3141730010762108126152188
thrombus.33517300107267297141213258304333350
(d)37227300107246790
Evaluation34084001074077120139184229255273318365
after7208400107456897133159
the89484001072672110
first1019840010723426799125
MAT.1159840010767116150162
(e)13368400107245981
Evaluation143284001074077120139184229255273318365
after18128400107456897133159
the198684001072672110
first2111840010723426799125
balloon225184001074591109127172218265
angioplasty.253184001074591136155200246264310340366405419
(f)29648400107244573
There305284001074087125151187
is325484001071948
a3317840010745
clot337784001073856101126
blocking351884001074664109148184203249294
the34095001072672110
aspiration46795001074575119138163206232250295342
catheter82595001073781107153191218254280
after11219500107466897134160
the129795001072672110
second142495001073168106149196241
MAT.1681950010768117151162
(g)18609500107236790
Evaluation196795001073976120138184229255273318365
after23489500107456897133159
intracoronary25239500107196590116158196239265309355400426466
thrombolysis30059500107267298141213258304323360391408437
and345895001074692137
balloon361195001074691110128173340106001074592
angioplasty.450106001074692137155200246265310340366406419
(h)88810600107247091
Post-stent998106001074286116142166197223260306331
evaluation1348106001073876120139184229255273318365
proximal1731106001074672116152170241286304
to2054106001072670
mid-RCA.2143106001077189135162207255305324
(i)248610600107244164
Angiography2568106001074995140158204250275318363410445
evaluation3032106001073877120139184229255273318365
434161060010741
days3476106001074590127158
after365310600107456897134159
primary34011700107457189161206231271
PCI627117001074391109
a4041350013758
b15301350013766
c26991350013750
d4042500013766
e15302500013758
f26992500013738
g4043670013764
h15303670013764
i26993670013730