Combined intracoronary streptokinase and percutaneous coronary angioplasty for reperfusion of chronic total coronary occlusion.

In a 40 year old man with a 1 month total occlusion of a dominant right coronary artery, persistent angina despite medical management indicated inadequate coronary collateral supply to the posterolateral myocardium originally supplied by the totally occluded vessel. Initial attempts at reperfusion of the chronically occluded vessel with an angioplasty guide wire and balloon were unsuccessful. However, administration of intracoronary streptokinase resulted in partial reperfusion, after which successful wire-guided balloon angioplasty was accomplished. This case illustrates the potential utility of combining a thrombolytic agent with angioplasty in attempting reperfusion for management of selected cases of chronic total coronary artery occlusion.