[Recanalization of an acutely occluded coronary bypass: combined local and systemic streptokinase administration].

Renewed severe angina occurred in a 57-year-old patient 14 months after a quadruple aortocoronary graft. Angiography demonstrated acute occlusion of a posterolateral graft. After 120 minutes of local streptokinase infusion (2000 IU/min) there was partial recanalization, with complete thrombolysis and graft recanalization after subsequent intravenous streptokinase infusion (30 000 IU/min for 90 minutes). Contrary to the situation in early postoperative graft thrombosis, acute late occlusion can be successfully lysed without increased risk of bleeding (haemopericardium).