Thrombolytic therapy of a stenosed coronary vein bypass graft with continuous intragraft streptokinase drip

A patient with newly onset angina due to recent thrombotic occlusion of a saphenous vein graft to the left anterior descending coronary artery is described. The patient was successfully treated by a direct intragraft infusion of streptokinase (STK) followed by a continuous intragraft infusion of an additional 1.5 million units of STK during the next 20 h through a regular diagnostic catheter. The patient was discharged on oral anticoagulant treatment with remarkable relief of the angina. Repeat angiography showed complete dissolution of the graft thrombus. This patient demonstrates that continuous infusion of STK into a saphenous vein graft is an effective treatment for recently formed thrombi.