title: Intracoronary thrombolysis followed by directional atherectomy: a combined approach for thrombotic vein graft lesions considered unsuitable for angioplasty.
abstract: Eccentric complex vein graft lesions with abundant luminal thrombus have been generally considered unfavorable for balloon angioplasty. We present 3 patients in whom such lesions were successfully treated by a combined approach: intracoronary urokinase (1 million units over 1 hr) administered in the catheterization laboratory followed by directional atherectomy of the residual lesions in 2 separate procedures; with the patients maintained on heparin infusion between the 2 stages. No distal embolizations were encountered. Two of the 3 patients developed a groin hematoma without vascular compromise. This combined approach may prove to be an attractive alternative to reoperation in select patients with unfavorable vein graft lesions.
authors.affiliation: Cardiac Catheterization Laboratory, Medical College of Virginia, Richmond.
authors.forename: M N
authors.initials: MN
authors.lastname: Sabri
authors.forename: D
authors.initials: D
authors.lastname: Johnson
authors.forename: M
authors.initials: M
authors.lastname: Warner
authors.forename: M J
authors.initials: MJ
authors.lastname: Cowley
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D003131:Combined Modality Therapy; D017023:Coronary Angiography; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000601:surgery*; D004691:Endarterectomy; D005260:Female; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000188:drug therapy*; D012086:Reoperation; D012501:Saphenous Vein / Q000637:transplantation*; D015912:Thrombolytic Therapy / Q000379:methods*; D014568:Urokinase-Type Plasminogen Activator / Q000008:administration & dosage*
chemical_list: D014568:Urokinase-Type Plasminogen Activator