Morand P, Meyer P, Guarino L, Baudouy M
Presse Med. 1984 Feb 11;13(5):275-9.
In more than 70% of the cases thrombi in the coronary arteries responsible for myocardial infarction can be dissolved by intracoronary injection of a fibrinolytic agent. For the left ventricular function to improve thrombolysis must be performed within 4 hours of thrombus formation; when performed later, results are inconstant. The risks of arteriography and thrombolysis (mostly dysrhythmias and haemorrhage) are real but acceptable. The mortality rate is lower than with conventional treatment. Improvement in left ventricular global ejection fraction is more pronounced in cases with collateral circulation and when thrombolysis is performed at an early stage. Thrombosis recurs within a few days in 15-20% of the cases. This can be prevented by aorto-coronary bypass or transluminal dilation of the stenotic vessel with a balloon catheter, either of these being carried out very early in cases with tight stenosis or delayed when the stenosis is significant but not life-threatening. A multicentre trial should be set up to find out whether intracoronary thrombolysis improves long-term survival and prevents late complications. But even if this were true, it should still be demonstrated that the method is as effective and safe as intravenous thrombolysis.
在超过70%的因心肌梗死导致的冠状动脉血栓病例中，通过冠状动脉内注射纤维蛋白溶解剂可溶解血栓。为使左心室功能得到改善，溶栓必须在血栓形成后4小时内进行；若在之后进行，效果则不稳定。动脉造影和溶栓的风险（主要是心律失常和出血）确实存在，但可以接受。死亡率低于传统治疗。在有侧支循环的病例以及早期进行溶栓时，左心室整体射血分数的改善更为显著。15% - 20%的病例会在数天内出现血栓复发。这可通过主动脉 - 冠状动脉旁路移植术或用球囊导管对狭窄血管进行经腔扩张来预防，在狭窄严重的病例中应尽早进行上述操作之一，若狭窄显著但不危及生命则可延迟进行。应开展一项多中心试验，以确定冠状动脉内溶栓是否能提高长期生存率并预防晚期并发症。但即便情况如此，仍需证明该方法与静脉溶栓一样有效且安全。
