COMBINED MECHANICAL AND THROMBOLYTIC TREATMENT FOR TOTALLY OCCLUDED BYPASS GRAFTS

Totally occluded venous grafts are usually less amenable to mechanical reperfusion alone (for example percutaneous transluminal coronary ang ioplasty, PTCA) because of the large mass of thrombotic material withi n the graft. A combined approach using mechanical and thrombolytic tre atment might therefore be more successful. Twenty one patients (20 mal es, one female) with a mean age of 64.5 (SD 5.6) years underwent angio graphy because of crescendo or unstable angina (n = 19) or myocardial infarction (n = 2) at a mean of 21.7 (18.6) days after onset of sympto ms (range 1-60). All patients had had coronary artery bypass grafting (CABG) at a mean of 8.02 (4.02) years (range 0.3-13 years) before the current admission. At catheterisation, totally occluded venous bypass grafts to the left anterior descending coronary artery or diagonal (n = 10), marginal (n = 6), or right coronary artery (n = 5) were found. A combination of PTCA and thrombolytic treatment (in eight patients ex tended thrombolysis for 24 hours) was successful in reopening the veno us graft in 16/21 patients (76.2%). Immediate complications included f emoral haematoma (4), distal embolisation (3), and infection in one pa tient. Out of 13 patients catheterised within three months, two had re occluded, seven had restenosis, while four had patent grafts. Recurren t PTCA (at least once more) was done in eight patients. At long term f ollow up of a mean of 26.7 (21.6) months (range 4-75 months), four pat ients were asymptomatic, eight still suffered from mild stable angina, while three had recurrent hospital admissions and needed a second cor onary artery bypass. A combination of thrombolytic treatment and PTCA is a feasible and practised approach to recanalise recently occluded v enous bypass grafts.