Case Report

Local Intracoronary Bolus Administration of Combination

Eptifibatide and Streptokinase in Rescue PCI
Dika Ashrinda, Zulfikri Mukhtar, Abdullah Afif Siregar, Ary Agung P, Syaifullah,
Komaria, Zunaidi Syahputra, Mariyetti K. Nasution, Marisa K. Hazrina

Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Sumatera Utara /
Haji Adam Malik General Hospital, Medan, North Sumatera

Introduction
Thrombolytic therapy by using streptokinase in STEMI with onset <12 hours had effectivity 30-40%. Thrombolytic
therapy failed, the rescue PCI could be done to dissolve occlusive thrombus. Eptifibatide or streptokinase in primary
PCI have been published. In this case, we reported local intracoronary bolus administration of combination
eptifibatide and streptokinase in patient acute STEMI with onset 1 hour and failed thrombolytic therapy.

Case Report
A male, 43 years old with STEMI, onset 1 hour symptom
received 1.5 millionU Streptokinase. During thrombolytic
therapy patient still had chest pain, ECG monitoring
showed VES. One hour after giving streptokinase, the
12 leads ECG, did not show any ST segment resolution.
Twelve hours after thrombolytic therapy, we performed
rescue PCI, and the patient received loading dose
aspirin 300 mg, clopidogrel 600 mg and simvastatin
40 mg. IV bolus of UFH 100 U/kg during procedure.

Figure 1. Diagnostic coronary angiography, Occlusive

thrombus at LAD vessel TIMI and MBG grades were 0

Figure 2. Thrombectomy by thrombus aspiration device

(TAD)

Figure 3. After recanalizing by manual thrombus

aspiration (TAD) device

Figure 4. After local Intra coronary bolus administration

of Eptifibatide 3.75 mg and Streptokinase 100 kU

Diagnostic coronary angiography showed total occlusive

thrombus at proximal LAD (TIMI grade 0). Guiding
Catheter (GC) XB 7f, 3.5, was inserted and guidewire
across occlusive thrombus into distal vessel.
Thrombectomy was performed by manual thrombus
aspiration device (TAD). After recanalizing, local
intracoronary bolus eptifibatide 3,75 mg (5 ml) diluted
with 10 ml of saline for 3 minutes was given, then
flushed with 2 ml saline and following by streptokinase
100 kU diluted with 5 ml of saline for 3 minutes via TAD.
Three minutes later, coronary angiography was
performed and continued with inserted, and deployed
direct drug eluting stent (DES) 3.5 x 18 mm (3-5 mm
more than length size stenosis).
In the last procedural bolus nitroglycerine (NTG) 100 g
via thrombus aspiration device was given and there
were no complications.

Results
The
primary
end
point
was
assessment of postprocedural rescue
PCI, TIMI and MBG were 3. There
were no complications of allergic
reaction, minor and major bleeding.

Figure 5. Stent deployment at proximal LAD

Figure 6. Final result, TIMI and MBG grades were 3

Conclusion
The using of local intracoronary bolus administration of combination
eptifibatide 3,75 mg and streptokinase 100 kU showed that successful to
dissolve occlusive thrombus in patient of STEMI with onset 1 hour and
failed thrombolytic therapy. It had been proved that final result showed
TIMI and MBG grades were 3.

REFERENCES
1. Hamza MA, Galal A, Sueilam S, et Al. Local Intracoronary Eptifibatide versus Mechanical Aspiration in Patients with Acute ST-Elevation Myocardial Infarction. International Journal of Vascular Medicine 2014:1-5. http://dx.doi.org/10.1155/2014/294065.
2. Sczer M, Cimen A, Aslanger E, et al. Effect of Intracoronary Streptokinase Administered Immediately After Primary Percutaneous Coronary Intervention on Long-Term Left Ventricular Infarct Size, Volume, and Function. J Am Coll Cardiol 2009;54:1065-71.