Intracoronary artery retrograde thrombolysis combined with percutaneous coronary interventions for ST-segment elevation myocardial infarction complicated with diabetes mellitus: A case report and literature review

Mingzhi Shen; Yichao Liao; Jian Wang; Xinger Zhou; Yuting Guo; Yingqiao Nong; Yi Guo; Haihui Lu; Rongjie Jin; Jihang Wang; Zhenhong Fu; Dongyun Li; Shihao Zhao; Jinwen Tian

doi:10.3389/fcvm.2022.962127

Intracoronary artery retrograde thrombolysis combined with percutaneous coronary interventions for ST-segment elevation myocardial infarction complicated with diabetes mellitus: A case report and literature review

Front Cardiovasc Med. 2022 Jul 22:9:962127. doi: 10.3389/fcvm.2022.962127. eCollection 2022.

Authors

Mingzhi Shen^{1

2}, Yichao Liao¹, Jian Wang¹, Xinger Zhou^{1

2}, Yuting Guo^{1

2}, Yingqiao Nong^{1

2}, Yi Guo¹, Haihui Lu¹, Rongjie Jin¹, Jihang Wang¹, Zhenhong Fu³, Dongyun Li⁴, Shihao Zhao¹, Jinwen Tian^{1

2}

Affiliations

¹ Department of Cardiology, Hainan Geriatric Disease Clinical Medical Research Center, Hainan Branch of China Geriatric Disease Clinical Research Center, Hainan Hospital of Chinese PLA General Hospital, Sanya, China.
² The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.
³ Department of Cardiology, Sixth Medical Center, PLA General Hospital, Beijing, China.
⁴ The First Department of Health Care, Second Medical Center of PLA General Hospital, Beijing, China.

Abstract

Background: The management of a large thrombus burden in patients with acute myocardial infarction and diabetes is still a worldwide problem.

Case presentation: A 74-year-old Chinese woman presented with ST-segment elevation myocardial infarction (STEMI) complicated with diabetes mellitus and hypertension. Angiography revealed massive thrombus formation in the mid-segment of the right coronary artery leading to vascular occlusion. The sheared balloon was placed far from the occlusion segment and urokinase (100,000 u) was administered for intracoronary artery retrograde thrombolysis, and thrombolysis in myocardial infarction (TIMI) grade 3 blood flow was restored within 7 min. At last, one stent was accurately implanted into the culprit's vessel. No-reflow, coronary slow flow, and reperfusion arrhythmia were not observed during this process.

Conclusion: Intracoronary artery retrograde thrombolysis (ICART) can be effectively and safely used in patients with STEMI along with diabetes mellitus and hypertension, even if the myocardial infarction exceeds 12 h (REST or named ICART ClinicalTrials.gov number, ChiCTR1900023849).

Keywords: diabetes mellitus; intracoronary retrograde thrombolysis; myocardial infarction; reperfusion preconditioning; thrombosis.

Publication types

Case Reports