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[Recanalization of an acutely occluded coronary bypass: combined local and systemic streptokinase administration]
Insights
Late graft occlusion can be successfully treated with streptokinase. This thrombolytic therapy effectively restored blood flow in a patient experiencing severe angina due to a blocked aortocoronary graft.
Area of Science:
- Cardiology
- Vascular Surgery
- Thrombolytic Therapy
Background:
- Severe angina can indicate serious cardiovascular events.
- Aortocoronary grafts are used to bypass blocked coronary arteries.
- Late graft occlusion poses a significant risk to patients post-surgery.
Observation:
- A 57-year-old patient presented with renewed severe angina 14 months after a quadruple aortocoronary graft.
- Angiography revealed acute occlusion of a posterolateral graft.
Findings:
- Local streptokinase infusion (2000 IU/min for 120 minutes) achieved partial graft recanalization.
- Subsequent intravenous streptokinase infusion (30,000 IU/min for 90 minutes) led to complete thrombolysis and graft recanalization.
- Successful lysis of acute late graft occlusion was achieved.
Implications:
- Acute late aortocoronary graft occlusion can be effectively treated with streptokinase.
- Thrombolytic therapy for late graft occlusion may not increase bleeding risk, unlike in early graft thrombosis.
- This approach offers a potential treatment option for patients with late graft occlusion and angina.
Abstract:
Renewed severe angina occurred in a 57-year-old patient 14 months after a quadruple aortocoronary graft. Angiography demonstrated acute occlusion of a posterolateral graft. After 120 minutes of local streptokinase infusion (2000 IU/min) there was partial recanalization, with complete thrombolysis and graft recanalization after subsequent intravenous streptokinase infusion (30 000 IU/min for 90 minutes). Contrary to the situation in early postoperative graft thrombosis, acute late occlusion can be successfully lysed without increased risk of bleeding (haemopericardium).