TREATMENT OF INTRACORONARY THROMBUS WITH LOCAL UROKINASE INFUSION USING A NEW, SITE-SPECIFIC DRUG-DELIVERY SYSTEM - THE DISPATCH(TM) CATHETER

Background: The presence of intracoronary thrombus significantly incre ases the risk of conventional balloon angioplasty because of a high in cidence of abrupt closure, distal embolization, and no-reflow phenomen on. The purpose of this study was to assess a new technique for treati ng intracoronary thrombus consisting of the local delivery of urokinas e directly to the angioplasty site with a novel, catheter-based, drug delivery system, Methods: The Dispatch catheter is a new local, drug-d elivery device that allows for the prolonged infusion of therapeutic a gents at an angioplasty site while still maintaining distal coronary p erfusion, Six patients with angiographic or clinical evidence of intra coronary thrombus were treated with 150,000 units of urokinase over a 30-min period using this device prior to or following conventional bal loon angioplasty and/or directional atherectomy, Results: Successful d elivery of urokinase directly to the angioplasty site was achieved in all 6 patients without hemodynamic or electrocardiographic compromise. In all six cases, focal urokinase therapy resulted in complete dissol ution of angiographic intracoronary thrombus and/or reduction of the c oronary stenosis, Limited ischemia due to sidebranch occlusion by the catheter's coils was noted in one patient, Distal embolization or no-r eflow phenomenon were not observed in any case, CONCLUSION: The local drug-delivery catheter used in this study was able to successfully and rapidly achieve intracoronary thrombolysis by delivering limited quan tities of urokinase directly to the angioplasty site, while still main taining distal coronary perfusion. This technique of local, thrombolyt ic drug delivery may be useful in the percutaneous treatment of intrac oronary thrombus and thrombus-containing stenoses. (C) 1994 Wiley-Liss , Inc.