Overview of intracoronary thrombolysis.

Despite these negative results, the theoretical benefit of lysing clot in acute coronary syndromes remains appealing. Whether the use of more potent antiplatelet agents or antithrombin agents might improve the results of thrombolytics in unstable angina and acute myocardial infarction without an unacceptable bleeding risk remains speculative. Site-specific lysis with a high local concentration of thrombolytic without systemic fibrinolysis has the appeal of potentially fewer bleeding complications, but the safety and efficacy of site-specific thrombolysis remains unclear. Early results with coronary stenting to maintain the largest lumen possible in combination with lytic agents in acute infarction appears favorable in a preliminary report. It is possible that reocclusion mediated by coronary obstruction with static flow cannot be salvaged with lytics alone, but the adjunctive use of stents or other interventions to decrease mechanical atherosclerotic obstruction may be beneficial in the future. However, planned and ongoing trials will be required before a beneficial role for adjunctive thrombolysis with angioplasty in acute ischemic syndromes can be established.