RECANALIZATION OF COMPLETELY OCCLUDED AOR TOCORONARY VENOUS BYPASS GRAFTS BY ANGIOPLASTY AND 24-HOUR LOCAL UROKINASE INFUSION

Recent occlusion of aortocoronary venous bypass grafts had occurred in three patients, aged between 64 and 67 years. In all three recanaliza tion was achieved after 8 hours, two and five days, respectively, of c oronary angioplasty combined with local urokinase infusion for 24 hour s. The procedure consisted of passing a guide-wire through the occlude d bypass graft, the tip of the wire then being advanced to the periphe ry of the native coronary artery. The balloon was then repeatedly dila ted along the length of the graft. Primary opening was not achieved in one of the grafts, and the other two closed again, despite repeated a nd prolonged balloon dilatation. In all three patients a coronary infu sion catheter was then placed into the graft lumen and urokinase (3 mi ll. units) infused over 24 hours. An angiogram 24 hours later demonstr ated an open bypass graft (residual stenosis < 50%). Angiography 9 to 14 weeks later revealed restenosis in one case, but it was reopened by balloon dilatation and stent insertion, while the other two had remai ned open without significant stenosis.