Scintigraphic and angiographic control of high-dose local streptokinase treatment of central pulmonary emboli

We describe thirteen patients who were treated by high doses of local streptokinase given for acute central pulmonary emboli. In order to reduce the risks of this treatment, we have developed a diagnostic-therapeutic scheme which has been applied to these patients uniformly. The scheme includes diagnosis made by scintigraphy and pulmonary angiography, thrombolysis by the application of high doses locally and continuous scintigraphic and angiographic control until the thrombus has disappeared totally, or at least to a large extent. The considerations for high-dose local treatment are discussed. Apart from one episode of bleeding which could be controlled, there were no local complications from the indwelling catheter. The oldest patient in the group, who suffered from obesity and severe generalised arterio-sclerosis, died on the second day of treatment from an intracranial haemorrhage. A second patient with subtotal embolisation died six hours after the beginning of treatment from therapy-resistant shock. The other patients were cured as far as their macroscopic emboli were concerned. Relapsing microembolism occurred in one patient after three months; the other patients remained free from relapsing pulmonary emboli. (orig.)