Coronary Hyperemic Dose Responses of Intracoronary Sodium Nitroprusside

Abstract

Background-Sodium nitroprusside is one of several agents considered effective for treating the no-reflow phenomenon during acute coronary interventions. However, the coronary hyperemic dose responses and systemic hemodynamic effects of intracoronary nitroprusside have yet to be determined in humans. The purpose of this study was to compare the hyperemic and hemodynamic responses of intracoronary nitroprusside to intracoronary adenosine in patients during cardiac catheterization with angiographically normal anterior descending arteries. Methods and Results-In 21 patients, coronary blood flow velocity (0.014-inch Doppler flow wire), heart rate, and blood pressure were measured in unobstructed left anterior descending coronary arteries at rest, after intracoronary adenosine (30-to 50-g boluses), and after 3 serial doses (0.3-, 0.6-, and 0.9-g/kg boluses) of intracoronary nitroprusside. Coronary reserve was calculated as hyperemia/basal coronary flow velocity. In an additional 9 patients with intermediate stenoses (53Ϯ7%), 14 fractional flow reserve (FFR) measurements (using 0.014-inch pressure wire) were performed with both intracoronary adenosine and nitroprusside (0.6 g/kg). Intracoronary nitroprusside produced equivalent coronary hyperemia with a longer duration (Ϸ25%) compared with intracoronary adenosine. Intracoronary nitroprusside (0.9 g/kg) decreased systolic blood pressure by Ͻ20%, with minimal change in heart rate, whereas intracoronary adenosine had no effect on these parameters. FFR measurements with intracoronary nitroprusside were identical to those obtained with intracoronary adenosine (rϭ0.97). Conclusions-Compared with adenosine, intracoronary nitroprusside produces an equivalent but more prolonged coronary hyperemic response in normal coronary arteries. Intracoronary nitroprusside, in doses commonly used for the treatment of the no-reflow phenomenon, can produce sustained coronary hyperemia without detrimental systemic hemodynamics. On the basis of FFR measurements compared with adenosine, sodium nitroprusside also appears to be a suitable hyperemic stimulus for coronary physiological measurements.

Impact of PercuSurge Device Conjugative With Intracoronary Administration of Nitroprusside on No-Reflow Phenomenon Following Primary Percutaneous Coronary Intervention

“…28 Additionally, although NTG is an effective vasodilator for large epicardial vessels, it is significantly less effective in the microvascular circulation. 28 On the other hand, NO, which is derived from NTP without the requirement for prior intracellular metabolism, 21 is a potent vasodilator in the resistance arteriolar circulation 19,29 and plays a significant role in controlling blood flow through the coronary microcirculation. 20,29 Furthermore, NO could positively affect latent collaterals or collateral blood flow by eliciting vasodilatation or inhibiting platelet aggregation in the vascular bed distal to the target lesion.…”

Selective Intracoronary Administration of Nitroprusside Before Balloon Dilatation Prevents Slow Reflow During Percutaneous Coronary Intervention in Patients With Acute Myocardial Infarction

“…20) Calcium channel blockers and adenosine are two of the most common intracoronary agents used to induce hyperemia. 20,21) Based on previous reports using a Doppler flow wire, 20,21) the hyperemia induced by both nitroprusside and adenosine greatly exceeded the hyperemia induced by calcium channel blockers such as diltiazem, verapamil, and nicardipine. Furthermore, intracoronary nitroprusside produces an equivalent but more prolonged coronary hyperemia than adenosine.…”

“…Furthermore, intracoronary nitroprusside produces an equivalent but more prolonged coronary hyperemia than adenosine. 20) Therefore, we postulated that nitroprusside would have a beneficial effect on the slow reflow phenomenon. In fact, some previous studies have shown the positive effects of intracoronary nitroprusside injection on the no reflow phenomenon in patients not only with angina pectoris 13) but also with AMI.…”

“…This finding supports the previous data. [13][14][15]20) If hypotension were to occur, the short half-life of nitroprusside protects against prolonged hypotension.…”

Impervious Coronary No-Reflow: A Case Study

“…Sodium nitroprusside and other nitrates alike, when given intracoronary, results in a greater and more prolonged vasodilation and myocardial hyperemia [17]. Several meta analyses have confirmed the benefit of intracoronary sodium nitroprusside for the prevention and treatment of coronary no re-flow phenomenon [18,19].…”