Abstract
The angiographic appearance of the coronary arteries during successful thrombolysis with urokinase was determined in 35 patients with acute myocardial infarction. The lysing process passed through several phases: (a) total coronary occlusion with a convex or irregular distal margin (phase 0); (b) increasing patency of the lumen (phase 1); (c) re-establishment of flow but with intraluminal filling defects and delayed distal flow possibly due to microemboli (phase 2); (d) partial or complete disappearance of the filling defects (phase 3); and (e) further widening of the lumen which eventually attains a smooth regular outline (phase 4). The angiographic features which indicate the presence of coronary thrombosis are occlusion with an irregular or scalloped margin, staining with contrast medium, and progressive patency of the occluded vessel showing intraluminal filling defects.
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- CHAPMAN I. MORPHOGENESIS OF OCCLUDING CORONARY ARTERY THROMBOSIS. Arch Pathol. 1965 Sep;80:256–261. [PubMed] [Google Scholar]
- Cernigliaro C., Sansa M., Campi A., Sante Bongo A., Rossi P. Intracoronary thrombolysis with urokinase in acute myocardial infarction. Effects on reperfusion and left ventricular wall motion. G Ital Cardiol. 1982;12(5):365–373. [PubMed] [Google Scholar]
- Chandler A. B., Chapman I., Erhardt L. R., Roberts W. C., Schwartz C. J., Sinapius D., Spain D. M., Sherry S., Ness P. M., Simon T. L. Coronary thrombosis in myocardial infarction. Report of a workshop on the role of coronary thrombosis in the pathogenesis of acute myocardial infarction. Am J Cardiol. 1974 Dec;34(7):823–833. doi: 10.1016/0002-9149(74)90703-6. [DOI] [PubMed] [Google Scholar]
- Chiang J., Kowada M., Ames A., 3rd, Wright R. L., Majno G. Cerebral ischemia. III. Vascular changes. Am J Pathol. 1968 Feb;52(2):455–476. [PMC free article] [PubMed] [Google Scholar]
- Cowley M. J., Hastillo A., Vetrovec G. W., Hess M. L. Effects of intracoronary streptokinase in acute myocardial infarction. Am Heart J. 1981 Dec;102(6 Pt 2):1149–1158. doi: 10.1016/0002-8703(81)90646-3. [DOI] [PubMed] [Google Scholar]
- Davies M. J., Woolf N., Robertson W. B. Pathology of acute myocardial infarction with particular reference to occlusive coronary thrombi. Br Heart J. 1976 Jul;38(7):659–664. doi: 10.1136/hrt.38.7.659. [DOI] [PMC free article] [PubMed] [Google Scholar]
- DeWood M. A., Spores J., Notske R., Mouser L. T., Burroughs R., Golden M. S., Lang H. T. Prevalence of total coronary occlusion during the early hours of transmural myocardial infarction. N Engl J Med. 1980 Oct 16;303(16):897–902. doi: 10.1056/NEJM198010163031601. [DOI] [PubMed] [Google Scholar]
- Friedman M., Van den Bovenkamp G. J. The pathogenesis of a coronary thrombus. Am J Pathol. 1966 Jan;48(1):19–44. [PMC free article] [PubMed] [Google Scholar]
- Ganz W., Buchbinder N., Marcus H., Mondkar A., Maddahi J., Charuzi Y., O'Connor L., Shell W., Fishbein M. C., Kass R. Intracoronary thrombolysis in evolving myocardial infarction. Am Heart J. 1981 Jan;101(1):4–13. doi: 10.1016/0002-8703(81)90376-8. [DOI] [PubMed] [Google Scholar]
- Hellstrom H. R. Coronary artery stasis after induced myocardial infarction in the dog. Cardiovasc Res. 1971 Jul;5(3):371–375. doi: 10.1093/cvr/5.3.371. [DOI] [PubMed] [Google Scholar]
- Hellstrom H. R. Coronary artery vasospasm: the likely immediated cause of acute myocardial infarction. Br Heart J. 1979 Apr;41(4):426–432. doi: 10.1136/hrt.41.4.426. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Hellstrom H. R. The injury-spasm (ischemia-induced hemostatic vasoconstrictive) and vascular autoregulatory hypothesis of ischemic disease. Resistance vessel-spasm hypothesis of ischemic disease. Am J Cardiol. 1982 Mar;49(4):802–810. doi: 10.1016/0002-9149(82)91962-2. [DOI] [PubMed] [Google Scholar]
- Hellstrom H. R. Vasospasm in ischemic heart disease--a hypothesis. Perspect Biol Med. 1973 Spring;16(3):427–440. doi: 10.1353/pbm.1973.0046. [DOI] [PubMed] [Google Scholar]
- Horie T., Sekiguchi M., Hirosawa K. Relationship between myocardial infarction and preinfarction angina: a histopathological study of coronary arteries in two sudden death cases employing serial section. Am Heart J. 1978 Jan;95(1):81–88. doi: 10.1016/0002-8703(78)90400-3. [DOI] [PubMed] [Google Scholar]
- Leaf A. Cell swelling. A factor in ischemic tissue injury. Circulation. 1973 Sep;48(3):455–458. doi: 10.1161/01.cir.48.3.455. [DOI] [PubMed] [Google Scholar]
- Levin D. C., Fallon J. T. Significance of the angiographic morphology of localized coronary stenoses: histopathologic correlations. Circulation. 1982 Aug;66(2):316–320. doi: 10.1161/01.cir.66.2.316. [DOI] [PubMed] [Google Scholar]
- Mason J. W., Strefling A. Small vessel disease of the heart resulting in myocardial necrosis and death despite angiographically normal coronary arteries. Am J Cardiol. 1979 Jul;44(1):171–176. doi: 10.1016/0002-9149(79)90267-4. [DOI] [PubMed] [Google Scholar]
- Mathey D. G., Kuck K. H., Tilsner V., Krebber H. J., Bleifeld W. Non surgical coronary artery recanalization in acute transmural myocardial infarction. Circulation. 1981 Mar;63(3):489–497. doi: 10.1161/01.cir.63.3.489. [DOI] [PubMed] [Google Scholar]
- Mathey D. G., Rodewald G., Rentrop P., Leitz K., Merx W., Messmer B. J., Rutsch W., Bücherl E. S. Intracoronary streptokinase thrombolytic recanalization and subsequent surgical bypass of remaining atherosclerotic stenosis in acute myocardial infarction: complementary combined approach effecting reduced infarct size, preventing reinfarction, and improving left ventricular function. Am Heart J. 1981 Dec;102(6 Pt 2):1194–1201. doi: 10.1016/0002-8703(81)90652-9. [DOI] [PubMed] [Google Scholar]
- Meyer J., Merx W., Schmitz H., Erbel R., Kiesslich T., Dörr R., Lambertz H., Bethge C., Krebs W., Bardos P. Percutaneous transluminal coronary angioplasty immediately after intracoronary streptolysis of transmural myocardial infarction. Circulation. 1982 Nov;66(5):905–913. doi: 10.1161/01.cir.66.5.905. [DOI] [PubMed] [Google Scholar]
- Reduto L. A., Freund G. C., Gaeta J. M., Smalling R. W., Lewis B., Gould K. L. Coronary artery reperfusion in acute myocardial infarction: beneficial effects of intracoronary streptokinase on left ventricular salvage and performance. Am Heart J. 1981 Dec;102(6 Pt 2):1168–1177. doi: 10.1016/0002-8703(81)90648-7. [DOI] [PubMed] [Google Scholar]
- Reduto L. A., Smalling R. W., Freund G. C., Gould K. L. Intracoronary infusion of streptokinase in patients with acute myocardial infarction: effects of reperfusion on left ventricular performance. Am J Cardiol. 1981 Sep;48(3):403–409. doi: 10.1016/0002-9149(81)90066-7. [DOI] [PubMed] [Google Scholar]
- Rentrop P., Blanke H., Karsch K. R., Kaiser H., Köstering H., Leitz K. Selective intracoronary thrombolysis in acute myocardial infarction and unstable angina pectoris. Circulation. 1981 Feb;63(2):307–317. doi: 10.1161/01.cir.63.2.307. [DOI] [PubMed] [Google Scholar]
- Rentrop P., Blanke H., Karsch K. R., Wiegand V., Köstering H., Rahlf G., Oster H., Leitz K. Widereröffnung des Infarktgefässes durch transluminale Rekanalisation und intrakoronare Streptokinase-Applikation. Dtsch Med Wochenschr. 1979 Oct 12;104(41):1438–1440. doi: 10.1055/s-0028-1129117. [DOI] [PubMed] [Google Scholar]
- Ridolfi R. L., Hutchins G. M. The relationship between coronary artery lesions and myocardial infarcts: ulceration of atherosclerotic plaques precipitating coronary thrombosis. Am Heart J. 1977 Apr;93(4):468–486. doi: 10.1016/s0002-8703(77)80410-9. [DOI] [PubMed] [Google Scholar]
- Vetrovec G. W., Cowley M. J., Overton H., Richardson D. W. Intracoronary thrombus in syndromes of unstable myocardial ischemia. Am Heart J. 1981 Dec;102(6 Pt 2):1202–1208. doi: 10.1016/0002-8703(81)90653-0. [DOI] [PubMed] [Google Scholar]











