SAFETY AND EFFICACY OF EXTENDED UROKINASE INFUSION PLUS STENT DEPLOYMENT FOR TREATMENT OF OBSTRUCTED, OLDER SAPHENOUS-VEIN DRAFTS

This study was designed to determine the safety and efficacy of extend ed, continuous infusion of urokinase plus stent deployment to treat ol der saphenous vein bypass grafts obstructed by both thrombus and ather omatous material. Thirty patients with angiographic evidence of thromb us and atheromatous material obstructing older vein grafts (mean age 8 .3 years) underwent the combined interventions of urokinase infusion a nd stent deployment. The continuous infusion of urokinase was administ ered directly into each obstructed vein graft over a mean of 20.5 +/- 8.1 hours (median dose 2.2 +/- 0.7 million units). Stents were deploye d at the sites of atheromatous obstruction either before (5 patients) or after (25 patients) infusion of urokinase. Twenty-eight of the 30 p atients were successfully treated with the combined interventions (suc cess rate 93.3%). In these 28 patients, percent diameter stenosis at t he site of obstruction decreased from 86.0% to -0.2% and Thrombolysis in Myocardial Infarction trial flow increased from 1.0 to 2.5. Two pat ients (6.7%) developed stent thrombosis followed by myocardial infarct ion (1 with Q-wave infarction, 3.3%) and congestive heart failure. Min or complications included non-Q-wave myocardial infarction (5 patients , 16.7%) and access-site hemorrhage (5 patients, 16.7%). At 2-week fol low-up, anginal symptoms were decreased in all 28 successfully treated patients. At 7.2 +/- 3.7-month follow-up, 5 of the 28 successfully tr eated patients (17.9%) had reacceleration of angina and angiographical ly documented restenosis at the site of stent deployment. Thus, the co mbined interventions are highly efficacious in treating older vein gra fts obstructed by both thrombus and atheromatous material, but are als o associated with significant procedural complications including stent thrombosis, myocardial infarction, and access-site hemorrhage.