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Prolonged intragraft urokinase with a new infusion wire: improved short-term results
P E Cundey1, R R Whitlock, J Norman
1University Hospital, Augusta, Georgia.
Insights
Recurrent angina in aged saphenous vein grafts is challenging. Intragraft urokinase infusion effectively debulks thrombus, enabling safer balloon angioplasty and reducing complications like restenosis.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
Background:
- Aged saphenous vein grafts frequently cause recurrent angina.
- Treating these patients is complex due to complications with standard angioplasty.
Purpose of the Study:
- To evaluate a novel method for treating aged saphenous vein grafts with recurrent angina.
- To assess the efficacy of intragraft urokinase infusion in managing graft occlusion.
Main Methods:
- Utilized prolonged intragraft urokinase infusion via a multiside hole catheter.
- Administered urokinase to debulk thrombus within the graft.
- Performed balloon angioplasty after thrombus debulking.
Main Results:
- Intragraft urokinase infusion successfully debulked thrombus.
- Balloon angioplasty was performed without the typical complications.
- This approach addresses thrombus-related occlusion in aged grafts.
Conclusions:
- Prolonged intragraft urokinase infusion is a viable treatment for aged saphenous vein grafts with recurrent angina.
- This method mitigates complications associated with direct balloon angioplasty.
- Thrombus management is key to successful intervention in these grafts.
Abstract:
Patients with aged saphenous vein grafts and recurrent symptoms of angina are being seen with increasing frequency [Bourassa: J Am Coll Cardiol 17:1081-1083, 1991]. The treatment of these patients remains a dilemma. Direct balloon angioplasty is frequently complicated by distal embolization and early restenosis [Aureran and Gruentzig: Am J Cardiol 53:953-954, 1984]. There is evidence that thrombus plays a significant role in this occlusive process [Hartmann et al.: J Am Coll Cardiol 18:1517-1523, 1991]. Prolonged intragraft urokinase infusion with a new multiside hole infusion catheter debulks thrombus and permits balloon angioplasty without the usual complications.