Intraoperative streptokinase. An adjunct to mechanical thrombectomy in the management of acute ischemia
L. H. Cohen, M. Kaplan and V. M. Bernhard
Streptokinase was injected directly into the arterial tree following
balloon-catheter embolectomy on 13 occasions to remove residual thrombus
that could not be mechanically retrieved in 12 patients with imminent limb
(ten patients) or kidney (two patients) necrosis. Effective lysis,
confirmed by arteriography, pulse return, and increased ankle pressures,
was achieved in 11 trials (85%). Bleeding complications, minor in three
patients and severe in two patients, were ascribed to systemic lysis
although other factors were contributory. One of five deaths was related to
therapy. Six limbs were salvaged. The average total dose of streptokinase
used, 110,000 units, was given in intermittent boluses of 25,000 to 50,000
units injected below a clamp placed to temporarily occlude distal
circulation. Safe application of this technique requires intraoperative
monitoring of coagulation parameters, aggressive replacement therapy, and
prudent patient selection. This preliminary experience suggests that
intraoperative lytic therapy (1) is an effective method for clearing
thrombus not amenable to mechanical extraction and (2) may improve patency
and tissue salvage.
