Dear Rowley,
Would be grateful if you could provide the relevant references that
thrombolysis is superior to primary angioplasty/PTCA. Our colleagues in
Japan and the US with whom we benchmark almost exclusively use
angioplasty for management of their MIs.
Anton
Rowley Cottingham wrote:
>
> Thrombolysis and primary angioplasty are not interchangeable. PTCA is designed to release a
> single or small number of discrete narrowings in an artery. It is best done as an elective
> procedure on a patent with stable angina. It is not effective on diffuse disease and rarely on a
> completely occluded vessel.
>
> However, thrombolysis is able to remove adherent clot from a fresh plaque rupture to allow flow
> past the plaque. However, it too is less successful if the vessel is completely occluded.
>
> PTCA needs a full cardiac surgery backup in case of dissection, and cost £4 to £5k per
> treatment. It is nice to have the backup for thrombolysis but it is less likely to lead to that sort
> of complication. We are now looking at thrombolysis followed by PTCA as gold standard; clot
> melted and then balloon to open vessel.
>
> Best wishes,
>
> Rowley Cottingham
>
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