Intravenous long-term thrombolysis of an occluded aortocoronary venous bypass graft

A 41-year-old man presented with progressive unstable angina pectoris during the last three hours. At admission the electrocardiogram and cardiac specific enzymes showed no signs of ischemia. During the next 24 hours the electrocardiogram and cardiac enzymes developed signs of a non-Q-wave anterolateral infarction. The patient had known coronary artery disease and underwent aortocoronary bypass surgery seven years ago. Coronary angiography after admission revealed a chronically occluded vein graft to the right coronary artery (RCA) and a subtotal occlusion of the vein graft to the left anterior descending artery (LAD) with a TIMI flow 0-I. Because of unfavorable results of mechanical revascularization of occluded bypass grafts and high risk of catheter dislocation and bleeding complications of intracoronary local thrombolysis, the patient subsequently received intravenous long-term thrombolysis for 24 hours. After successful lysis of the thrombus the bypass graft to the LAD showed two severe stenoses but blood flow has returned to normal. Three days later percutaneous transluminal coronary angioplasty (PTCA) and stent implantation were carried out with a good primary angiographic result. After 6 months the patient was still asymptomatic and a treadmill exercise test showed no signs of ischemia.