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Materials and MethodsTwelve patients with angiographically demonstrated arterial occlusions were treated by low dose streptokinaseafter diagnosticangiography.The cathetertip was embeddedin the thrombus or was placed as close as possible to the site of occlusion. Streptokinase was infused at 5,000 U/hr, an arbitrarily determined dose 1/20th of the systemic dosage (100,000 U/hr). The duration of infusion varied from 5 to 16 hr. Infusion was not terminated until follow up arteriography was completed. Therefore, the precise duration of infusion before clot lysis was not always known.All patientsweremonitoredin an intensivecare unitduringtherapy.Successof therapy wasdocumented clinicallybyphysical examination andrepeatarteriographybeforeremoval of the catheter.Preliminaryclotting statusevaluationincludedmeasurement of thrombin time, prothrombin time, partial thromboplastin time, fibninogen, and fibrin split products. Patients were typed and screened for two units of packed cells for possible transfusion. Strict orders were given to avoid intraarterial or intramuscular injections and to place intravenous punctures peripherally where they would be easily compressible.

In a retrospective analysis, the efficacy of lysis, the degree of systemic thrombolytic effect, and the rate of complications during local thrombolytic therapy with either streptokinase (SK) or urokinase (UK) were compared in 47 patients. There were 24 infusions of each agent; one patient in the UK group received two infusions. The overall efficacy of lysis was better in the UK-treated group (80% vs. 63%). The UK group had a lower frequency of systemic thrombolytic effect and of bleeding complications. SK antibody titers were measured in all patients who received infusions. Patients with high titers who were treated with SK responded poorly (20% lysis); patients with low titers responded at a rate equal to that of UK-treated patients. Three patients with high titers of SK antibodies did not respond to SK, but subsequent successful lysis did occur with UK. In conclusion, UK is believed to be preferable to SK for local thrombolytic therapy due to increased efficacy of lysis and decreased rate of systemic fibrinolytic effect and bleeding complications.

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