Late thrombolysis of an occluded aortocoronary saphenous vein graft

Reprint requests: Mark J. Goldberg, M.D., Dept. of Medicine, Section of Cardiovascular Diseases, Sinai Hospital of Detroit, 6767 West Outer Dr., Detroit, MI 48235. vein graft. Thrombolysis was “late,” both in the sense that graft occlusion occurred several weeks after surgery, and that treatment was administered several days after the onset of symptoms. We believe this represents a promising new application for streptokinase therapy. JP, a 53-year-old male with unstabie angina and a history of previous myocardial infarction, underwent coronary angiography on July 27, 1982. The study revealed a 70 % stenotic lesion in the proximal left anterior descending artery, a 90 % stenotic lesion in the proximal portion of a relatively large intermediate branch, and total proximal occlusion of the right coronary artery. Left ventriculography showed normal segmental wall motion, with the left ventricular ejection fraction being 58%. Coronary artery bypass graft surgery was performed on August 4, 1982. Saphenous vein grafts were fashioned for the left anterior descending artery, the intermediate branch, and the posterior descending branch of the right coronary artery. The early postoperative course was uneventful. The patient was discharged in excellent condition 7 days after surgery.