SUCCESSFUL TREATMENT OF A LARGE INTRACORO NARY THROMBUS WITH UROKINASE AND A CHIMERICAL MONOCLONAL PLATELET-AGGREGATION INHIBITOR

History and clinical findings: 7 days after an operation for intervert ebral disc prolapse a 43-year-old man was referred with the clinical a nd ECG signs of an acute posterior wall myocardial infarction. Investi gations: Creatine kinase (CK) activity was raised to 204 U/l (myocardi al-specific isoenzyme CKMB of 23.6 U/l, 11.6% of total) and glutamatic -oxalate transferase (GOT) activity to 37 U/l. Emergency cardiac cathe terisation, performed 4 hours after renewed onset of precordial pain s howed no abnormal findings in the right coronary artery, despite the E CG signs, but a definite filling defect in the anterior interventricul ar branch which on intravascular ultrasound was an echo-dense noncalci fied structure. Treatment and course: After percutaneous transluminal coronary angioplasty in the area of the obstructing structure al free- floating mass was identified in the proximal part of the anterior inte rventricular branch, most likely a thrombus. Intercoronary thrombolysi s was therefore undertaken with urokinase (bolus of 1 mill. IU) togeth er with the chimerical mono-clonal antibody c7E3, which inhibits plate let aggregation by blocking the platelet glycoprotein surface receptor IIb/IIIa. Coronary angiography 12 hours later revealed almost complet e dissolution of the previously obstructing mass. Conclusion: Combinin g the platelet aggregation inhibitor c7E3 with a thrombolytic agent is an alternative treatment to the current management of intracoronary t hrombi. Intravascular ultrasound is a suitable method for demonstratin g angiographically inconspicious or unclear but pathogenetically signi ficant vessel changes.