[Thrombolytic therapy of arterial occlusions]

Systemic as well as local applications of thrombolytic agents can both be used in the treatment of arterial occlusive disease. Systemic thrombolysis yields the best results in recent arterial occlusions, while local intrathrombotic infusion of thrombolytic agents is also effective in chronic occlusions. In Germany the ultra-high-dose short-term infusion of streptokinase is widely used in systemic thrombolytic therapy. Urokinase and rt-PA are used in local thrombolytic therapy, because they show fewer side effects than streptokinase. The advantages of local thrombolytic therapy as compared to systemic infusions are a higher success rate, immediate angioplasty of underlying arterial stenoses during one procedure, and the demand for lower doses of thrombolytic agents. Despite the broad application of both techniques in current clinical practice there are virtually no comparative studies of both methods, nor are there studies that compare thrombolytic therapy with other revascularisation procedures (i.e. angioplasty, surgery).