Quantitative and qualitative effects of intracoronary streptokinase in @entity1459 and non-Q wave XXXX .

@entity1 @entity2002 @entity301 @entity63 @entity75 @entity1459 @entity1188 @entity583 @entity715
Thrombolytic therapy has been shown to be effective in reopening totally occluded arteries in @entity583 . @entity301 is also believed to play a role in the pathophysiology of @entity1459 and non-Q wave @entity1188 . However, few @entity1 with these two acute @entity301 have been treated with intracoronary streptokinase. Therefore, 100,000 to 300,000 IU (mean 177,000 +/- 80,000 IU) of intracoronary streptokinase was infused into 36 consecutive catheterized @entity1 who either presented with an acute episode of @entity1459 or had had a recent non-Q wave @entity1188 and in whom a less than 100% occluded @entity63 -producing artery could be identified. Qualitative techniques utilizing vessel magnification and quantitative analysis with digital subtraction were performed on the @entity63 -producing coronary lesion before and immediately after streptokinase therapy and 3 to 10 days later in 18 @entity1 who were restudied at the time of transluminal coronary angioplasty. Before streptokinase treatment, 24 (67%) of 36 @entity63 -producing arteries contained eccentric, irregular lesions. The percent diameter stenosis and percent area stenosis in all @entity63 -producing arteries averaged 83.8 +/- 8.3% and 94.8 +/- 3.3%, respectively. After streptokinase treatment there were 23 arteries (64%) with @entity75 . The percent diameter stenosis and percent area stenosis in all @entity63 -producing arteries were similar to pre-streptokinase values (82.9 +/- 5.9% and 93.8 +/- 4.0%, respectively). At restudy, there were also no significant changes in any quantitative or qualitative variable. Five individual @entity1 showed a significant reduction in percent stenosis after streptokinase. This improvement was independent of duration of symptoms, use of heparin before angiography, streptokinase dose or reduction of @entity2002 levels post-streptokinase. Two additional @entity1 deteriorated clinically and developed total occlusion of the @entity63 -producing artery within 12 hours of streptokinase infusion. These data suggest that intracoronary streptokinase may be of limited utility in either @entity1459 or recent non-Q wave @entity1188 with a less than 100% occluded @entity63 -producing artery. In these syndromes, @entity715 may be organized or short infusions may be given too late to be effective. In some cases, @entity715 may even be absent. Whether longer infusion of streptokinase or other thrombolytic agents will be of benefit remains to be determined.
