Coronary Venous Retroperfusion and Streptokinase Retroinfusion

Abstract

An alternative method of streptokinase administration via coronary veins was examined in a limited series of closed-chest dogs with intracoronary thrombogenic coil-induced thrombosis. Applying a small streptokinase dosage (1000–2000 IU min−1) approximately 90 min from coil insertion into the proximal LAD coronary artery, thrombosis was treated by three methods (5 dogs each): (1) intermittent 10-min retrograde injections into the balloon-occluded great cardiac vein, separated by 10 min without treatment and with free coronary venous drainage; (2) continuous retrograde administration along with great cardiac vein synchronised retroperfusion of arterial blood; and{3) systemic administration simulating failed coronary venous retroinfusion. Lysis of the coronary artery clot supervened in all 15 dogs, although at different times. The results of the two retrograde techniques were similar, and exhibited initial lysis within 26·7±9·2 min (range 18–35 min) which was fully established and stabilised within 50·5±13·2 min (range 27–75 min). In contrast, corresponding initial and stable systemic lysis times were significantly longer, 75·0±35·0 min (range 50–115 min) and 113·6±60·6 min (range 65–200 min), respectively. Retrograde lysis was not associated with arrhythmias, and there was no evidence of myocardial haemorrhages. Coronary venous streptokinase administration combined with synchronised retroperfusion provides relatively rapid lysis as well as a retrograde circulatory support which extends myocardial viability and improves myocardial perfusion and cardiac function. Further studies of this alternative approach are recommended.