Recanalization of an acutely occluded aortocoronary bypass by intragraft fibrinolysis.

Acute thrombotic occlusion of an aortocoronary bypass graft to the left anterior descending coronary artery (LAD) was successfully dissolved by selective infusion of streptokinase into the graft at 2000 U/min for 1 hour via catheter. There was partial recanalization of the graft and complete filling of the LAD within 15 minutes. After 1 hour of lysis, the graft was completely patent, although high-degree narrowing at the site of the proximal anastomosis was still present. Follow-up angiography 16 days later revealed persistent patency of the graft and disappearance of narrowing at the site of proximal anastomosis. The relatively low total dose of streptokinase (140,000 U) did not result in a systemic hyperlytic state. There were no complications. The technique may prove useful in acute graft occlusion but needs further evaluation.