Intracerebral hemorrhage complicating urokinase infusion into an occluded aortocoronary bypass graft

Area of Science:

• Cardiology
• Neurology
• Vascular Surgery

Background:

• Coronary artery bypass grafting (CABG) is a common surgical procedure.
• Occluded saphenous vein grafts (SVGs) are a significant cause of CABG failure.
• Selective intra-graft thrombolysis using agents like urokinase aims to restore graft patency.

Observation:

• A patient with known cerebral vascular structural pathology underwent selective intra-graft urokinase infusion for an occluded bypass vein graft.
• The procedure was complicated by the occurrence of intracerebral hemorrhage.
• The patient had no recent clinical complications related to their cerebral vascular condition prior to the procedure.

Findings:

• Intra-graft urokinase infusion, while effective for restoring patency in occluded coronary bypass vein grafts, carries a risk of serious complications.
• Intracerebral hemorrhage is a potential adverse event, particularly in patients with underlying cerebral vascular abnormalities.
• The risk-benefit profile of thrombolysis needs careful consideration in patients with pre-existing cerebrovascular disease.

Implications:

• Clinicians should exercise caution when considering selective intra-graft urokinase infusion in patients with a history of cerebral vascular structural pathology.
• Pre-procedural screening for cerebrovascular abnormalities may be warranted in select patients undergoing graft thrombolysis.
• Further research is needed to define optimal patient selection criteria and risk mitigation strategies for thrombolytic therapy in bypass graft interventions.