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European Heart Journal 1990 11(10):936-944;
Copyright © 1990 by the European Society of Cardiology.
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© 1990 The European Society of Cardiology

More rapid thrombolysis with coronary venous retroinfusion of streptokinase compared with intravenous administration An experimental study in canines

A. MIYAZAKI, N. HATORI, H. TADOKORO, L. RYDÉN, E. CORDAY and J. DRURY

Division of Cardiology, Department of Medicine, Cedars-Sinai Medical Center and the University of California Los Angeles, School of Medicine, Los Angeles, California, U.S.A.

Received 26 May 1989; revised 20 November 1989; .

Correspondence to: J. Kevin Drury, MD, Cedars-Sinai Medical Center, Halper Research Building, 3rd Floor, 8730 Beverly Blvd., Los Angeles, CA 90048, U.S.A

Abstract

The efficacy of coronary venous retroinfusion vs intravenous administration of streptokinase was compared in 20 closed chest dogs with copper coil induced thrombosis of the left anterior descending coronary artery. Streptokinase was continuously infused for 60 min (100 IU kg–1 min–1) starting 60 min after coronary artery occlusion. Time to clot lysis was determined by coronary angiography performed at 5 min intervals.

Complete lysis occurred in eight out of 10 dogs receiving intravenous streptokinase and in all 10 dogs in the coronary venous group. Time to thrombolysis was significantly shorter with coronary venous retroinfusion (23 ± 8 min) than after systemic infusion (62 ± 26 min; P < 0.001). Recovery of ischaemic zone left ventricular systolic function, studied by two-dimensional echocardiography, was significantly better in the animals that received retrograde streptokinase than in the group that received intravenous streptokinase (17 ±12% vs-2 ±16%; P < 0.05). Myocardial necrosis expressed as a percentage of the risk area was 8 ±12% after retroinfusion of streptokinase compared with 32 ±25% (P < 0.005) after intravenous administration.

In conclusion, coronary venous administration of streptokinase was more effective than intravenous therapy as determined by more rapid clot lysis which resulted in improved functional recovery of the ischaemic myocardium and a significant reduction in myocardial necrosis.

Key Words: Coronary venous retroinfusion • streptokinase • thrombolysis • experimental myocardial infarction


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