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According to Vollmar (1990) there were approximately 600 000 cases of iliofemoral venous thromboses in Germany in 1982 (23). Heinrich and Klink (1981) have calculated that 25%-50% of deep venous thomboses may lead to pulmonary embolism (PE). Beneke (1973) calculated lethal complications of PE at 24.7%. In the USA the incidence of lethal PE has been estimated at 50000-200000 patients every year (Zwaan et al. 1995). According to Schwarz (1965) there is an increasing tendency of severe PE in the First World in spite of mechanical and chemical prophylaxes to be discussed.

The development of chronic arterial occlusion is due to three processes: the first step is an arteriosclerotic lesion of the intima. Causes under discussion are: radiation (Nylander et al. 1978; Silverberg et al. 1978), carbon monoxide (Marshall et al. 1978), high blood pressure (Wooshmann and Nitschkoff 1966), lipid infiltration (Doerr 1963; Kannel et al. 1979), and old age (Schoop and Schmidtke 1973).

Recent experimental studies [2,3, 14] as well as clinical investigations [4, 11, 15, 17] have demonstrated the efficacy of intrathecally administered tissue plasminogen activator (rtPA) in lysing subarachnoid hematomas . Encouraged by these results, we performed local fibrinolytic therapy with rtPA in eight patients with severe intraventricular hemorrhage (IVH) and three patients with large intracerebral hematomas.

Recent experience with a limited number of patients at several institutions using local infusion of fibrinolytic agents suggests that early use of intraarterial urokinase-type plasminogen activator (u-PA) and streptokinase may effect clinical improvement without unacceptable intracerebral hemorrhagic complications. This report summarizes the results of two recently published studies on intraarterial thrombolytic therapy in acute carotid territory and in acute vertebrobasilar stroke.

Local fibrinolytic therapy using interventional neuroradiological techniques give a new chance in therapy in acute stroke [8]. In particular, vertebrobasilar disturbances are important indications [7], Local lysis, however, is often difficult, time-consuming, and needs permanent attention by specially trained staff. Thus the positive results of systemic fibrinolytic therapy in myocardial infarction (e. g., [6]) have resulted in new studies using clot-specific agents, particularly recombinant tissue plasminoge activator (rt-PA) in stroke. Experience gained in treating acute myocardial infarction (AMI), with prourokinase (PUK), and especially the low incidence of bleeding complications (e. g., [2]), led to the use of PUK in stroke therapy. In this contribution, results from five patients treated with PUK as a clot-specific agent are presented. Target points were the clinical time-course and the monitoring of fibrinolytic effects.

The application of fibrinolytic therapy to patients in the acute stage of ischemic stroke has been actively discussed since the 1960s [6]. No conclusion concerning its efficacy has been achieved to date, although tissue plasminogen activator (t-PA) with its potent lytic activity and thrombus-specific affinity has become clinically available.

Thrombosis of a coronary artery is the most common cause of myocardial infarction (DeWood et al. 1980). Thrombolytic therapy, when instituted timely, has been shown capable of reducing morbidity and mortality (GISSI 1986). Problems remain, however, including resistance to fibrinolytic therapy, delays in reperfusion, reocclusion after successful thrombolysis and serious hemorrhage (Coller 1990).

The most common vascular emergencies from the internistic point of view are acute arterial occlusion by emboli or thrombosis and acute thrombophlebitis of the superficial and deep veins.

The primary therapy used by nearly all physicians in the management of acute pulmonary embolism is anticoagulation. Although fibrinolytic agents have been available for over 15 years, their indication and degree of usefulness in pulmonary embolism are still not completely established. In acute pulmonary embolism, the action of heparin is only preventive by drastically reducing the risk of further emboli while natural lytic process removes thrombi from pulmonary and venous circulation. Thus, the clinical need does persist for an agent that would act safely on the morbid event, i. e. that would dissolve thromboemboli.

Local application of streptokinase into the stenosed coronary artery was introduced in our department of cardiology at the beginning of 1980. The criteria which must be fulfilled before the procedure may be performed are: 1. Time since onset of chest pain 3 hours or less 2. Typical myocardial infarction findings on ECG 3. No absolute contraindication to streptokinase or anticoagulant therapy.

In recent years, there has been an increase in the incidence of peripheral arterial thromboembolic disease. This has been attributed to an increase in the number of elderly patients with cardiovascular disease, as well as the number of vascular surgical procedures being performed. In the last decade, embolic complications of percutaneous transluminal angioplasty (PTA) have also contributed to this phenomenon [1].

Actually, three methods of treatment are available for reopening stenosed or occluded peripheral arteries — direct arterial surgery, fibrinolytic therapy with streptokinase or urokinase, and transluminal dilatation or recanalization. Long occlusions in the iliac or femoral region can — with a few exceptions — only be reopened by surgical techniques, whereas short occlusions and stenoses are accessible to transluminal catheter therapy. In contrast to reopening procedures, physical training aims at a better development of the collateral pathways and an improvement of the metabolic process involved in intermittent claudication.

Results of percutaneous transluminal angioplasty (PTA) followed by fibrinolytic therapy have already been reported. Another therapeutic scheme using lytic and catheter methods is established by the sequence: clearance by fibrinolysis → widening of a remaining arterial stenosis by PTA. The present study deals with ten cases in which this multistage treatment was performed.