Short-duration, high-dose urokinase infusion for recanalization of occluded saphenous aortocoronary bypass grafts

Marx, M; Armstrong, William P.; Wack, Jon P.; Bernstein, Robert; Brent, Bruce N.; Francoz, Richard; Gregoratos, Gabriel

doi:10.2214/ajr.153.1.167

Cited by 19 publications

(5 citation statements)

References 8 publications

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“…Furthermore, thrombus can also be a vexing problem following angioplasty as dissection and platelet deposition renders the artery highly thrombogenic [4]. Prolonged infusion of intra-arterial Urokinase has been previously reported in the recanalization of occluded saphenous vein bypass grafts [5,6]. However, no information is available regarding the use of prolonged Urokinase infusion in native vessels or patent vein grafts.…”

Section: Ptca In This Setting Results In Increased Complicationmentioning

confidence: 99%

Rapid thrombus dissolution by continuous infusion of urokinase through an intracoronary perfusion wire prior to and following PTCA: Results in native coronaries and patent saphenous vein grafts

Chapekis

George

Candela

1991

Cathet. Cardiovasc. Diagn.

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Even with aspirin and heparin therapy, thrombus present prior to or forming after percutaneous transluminal coronary angioplasty (PTCA) results in significant complications. We report on 33 patients who were treated with continuous infusion of Urokinase through an intracoronary perfusion wire for 24 hr because of visible intracoronary thrombus. Seventeen native vessels (9 pre-PTCA and 8 post-PTCA) and sixteen saphenous vein grafts (12 pre-PTCA and 4 post-PTCA) were treated. All vessels were patent at the time of perfusion wire placement. Complete thrombus resolution, successful PTCA and sustained patency was seen in 31 of 33 patients. One native vessel treated post PTCA (originally occluded) re-occluded. One saphenous vein graft treated prior to PTCA showed improvement in thrombus but distal embolization with balloon inflation occurred. No significant complications related to the intracoronary infusion technique were observed. In conclusion, rapid lysis of intra-coronary thrombus can be accomplish safely using this technique and can result in improved PTCA outcome.

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Section: Ptca In This Setting Results In Increased Complicationmentioning

confidence: 99%

Rapid thrombus dissolution by continuous infusion of urokinase through an intracoronary perfusion wire prior to and following PTCA: Results in native coronaries and patent saphenous vein grafts

Chapekis

George

Candela

1991

Cathet. Cardiovasc. Diagn.

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“…Alternatively, slower infusion might allow for more homogeneous clot dissolution, decreasing the likelihood of distal embolization. Intragraft infusion rates for urokinase ranging from 100,000 units/ hr to 360,000 units/hr have been reported [7,11].…”

Section: Discussionmentioning

confidence: 99%

“…Chapekis [ 181 positions the infusion catheter proximal to the clot in arteries or grafts which are not completely occluded. Some investigators have placed an infusion catheter into the thrombus [4,6,9,1 I], punctured the thrombus with a guide wire [6,7], or simply infused urokinase through a catheter at the os of the graft [8]. The optimal strategy remains to be determined.…”

Section: Discussionmentioning

confidence: 99%

Acute myocardial infarction complicating urokinase infusion for total saphenous vein graft occlusion

1993

Cathet. Cardiovasc. Diagn.

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Saphenous vein graft occlusions have been successfully treated with extended urokinase infusions. We report a case of myocardial infarction complicating this treatment. A review of reported cases suggests that this complication may not be uncommon. The optional drug, dose, and infusion technique for intra-graft lytic therapy has not been determined. The costs, risks, and difficulty of this technique may limit its application.

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“…The native circulation has even a higher propensity to direct blood away from occluded vessels making subselective administration a superior technique. It should be noted that several patients have been reported to develop acute myocardial infarction when the infusion is performed through the guiding catheter alone [7]. Early intravenous systemic thrombolytic therapy has been given to patients having acute coronary artery vein graft closure resulting in myocardial infarction [ 111 in which 5 patients underwent successful thrombolysis using t-PA for vein graft occlusion.…”

Section: Discussionmentioning

confidence: 99%

Sequential proximal and distal infusion of urokinase resulting in recanalization of acutely occluded aortocoronary bypass graft after coronary angioplasty

Bell

Kaiser

1992

Cathet. Cardiovasc. Diagn.

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Short-duration, high-dose urokinase infusion for recanalization of occluded saphenous aortocoronary bypass grafts

Cited by 19 publications

References 8 publications

Rapid thrombus dissolution by continuous infusion of urokinase through an intracoronary perfusion wire prior to and following PTCA: Results in native coronaries and patent saphenous vein grafts

Rapid thrombus dissolution by continuous infusion of urokinase through an intracoronary perfusion wire prior to and following PTCA: Results in native coronaries and patent saphenous vein grafts

Acute myocardial infarction complicating urokinase infusion for total saphenous vein graft occlusion

Sequential proximal and distal infusion of urokinase resulting in recanalization of acutely occluded aortocoronary bypass graft after coronary angioplasty

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