Urokinase infusion after unsuccessful angioplasty in patients with chronic total occlusion of native coronary arteries.

Percutaneous transluminal coronary angioplasty (PTCA) is often unsuccessful in patients with chronic total occlusion of coronary arteries. In this study, prolonged urokinase infusion (< or = 24 hr) was administered to 20 patients with chronic total coronary artery occlusion in whom previous PTCA had failed. An intracoronary bolus of urokinase, 120,000 IU, was followed by urokinase infusion, up to 200,000 IU/hr, if necessary, until angiography demonstrated reperfusion and a guiding wire could be advanced past the occlusion site. These results were achieved in 18 of the 20 cases. The two failures occurred early in the series, when the maximum urokinase infusion rate was 120,000 IU/hr. All but one patient with re-established flow subsequently had successful PTCA. Urokinase infusion was well tolerated, with no evidence of intramyocardial hemorrhage. Pretreatment with prolonged urokinase infusion appears to increase the likelihood of successful PTCA in patients with chronic total occlusion of coronary arteries.