Direct coronary stenting without balloon predilation in acute coronary syndromes

Hamon, Martial; Richardeau, Yves; Lecluse, E.; Saloux, Éric; Sabatier, Rémi; Denis, Arnaud; Filmont, Jean-Emmanuel; Grollier, Gilles; Potier, J C

doi:10.1016/s0002-8703(99)70246-2

Cited by 66 publications

(40 citation statements)

References 22 publications

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“…On the other hand, there were only 3 patients (2%) in Group A who underwent direct stent implantation without predilation. Previous studies [25][26][27][28][29] have demonstrated that direct stenting without balloon predilation reduces the slow flow and no-reflow phenomena and therefore, direct stenting might have influenced the achievement of blush-3 in this study.…”

Section: Study Limitationsmentioning

confidence: 73%

Effectiveness of Thrombectomy Before Stent Implantation in Acute Myocardial Infarction

Kawaguchi

Hara

Hirathuji

et al. 2003

Circ J

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hrombus formation after plaque rupture is the cause of vessel occlusion in acute myocardial infarction (AMI) and early, complete revascularization can salvage myocardium at risk and improve survival. 1 Primary angioplasty and stent implantation are important therapeutic options 2,3 and are associated with a higher reperfusion rate than pharmacological therapy alone. 4 However, these procedures can involve mobilization of thrombus and atheroma elements, causing distal embolization, the no-reflow phenomenon and impairment of the microcirculation, which reduce the clinical benefit of primary angioplasty. [5][6][7][8][9][10] The recent development of many kinds of thrombectomy device has made it possible to aspirate and remove intracoronary thrombotic material.The purpose of the present study was to evaluate the effectiveness of pretreatment by thrombectomy on myocardial salvage after stent implantation in patients with AMI.

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Section: Study Limitationsmentioning

confidence: 73%

Effectiveness of Thrombectomy Before Stent Implantation in Acute Myocardial Infarction

Kawaguchi

Hara

Hirathuji

et al. 2003

Circ J

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“…Kunichika et al (40) reported that tirofiban, a glycoprotein receptor inhibitor, decreased the extent of infarct and no-reflow incidence. Lower incidence of no-reflow phenomenon has been reported in patients undergoing direct stenting without predilation (41). Two large trials demonstrated that a distal occlusive protection device and a rheolytic thrombectomy device did not improve myocardial reperfusion, compared with conventional primary PCI (42,43).…”

Section: Discussionmentioning

confidence: 97%

Relationship between no-reflow phenomenon and serotonin levels in patients with acute ST-elevation myocardial infarction who underwent primary percutaneous intervention

Topsakal¹,

Kaya²,

Karakaya³

et al. 2010

Anadolu Kardiyol Derg

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Objective: Our aim was to investigate the effects of serotonin, which is a severe vasoconstrictor agent, on the occurrence of no-reflow phenomenon. Methods: In this cross-sectional controlled study, 40 patients, admitted to our clinic with chest pain in the first 12 hours and underwent primary percutaneous coronary intervention because of acute myocardial infarction were enrolled. Patients with TIMI 0 grade basal flow and normal post-procedure flow were included in group 1 and patients with flow grade TIMI ≤were enrolled in group 2. To measure the serotonin levels, blood samples were collected from the coronary ostium before the procedure. Results: In group 1, there were 25 patients (20 males, 5 females) and the mean age was 58±11 years; in group 2 there were 15 patients (13 males, 2 females) and the mean age was 62±8 years. The mean serotonin level in platelet in group 1 was 476±208 ng/10 9 platelet and in group 2-542±273 ng/10 9 platelet. The difference was not statistically significant (p=0.39). When we compared the serum serotonin levels, it was 41.4±40.8 ng/ml for group 1, but 66.7±45.7 ng/ml for group 2. Although the serum serotonin levels were higher in group 2, the difference was not statistically significant (p=0.07). Conclusion: There was no effect of serotonin level in the development of no-reflow, in patients to whom primary coronary percutaneous intervention was applied. (Anadolu Kardiyol Derg 2010; 10: 253-9) Key words: No-reflow phenomenon, serotonin, vasoconstriction, myocardial infarction ÖZET Amaç: Çalışmamızın amacı, vazokonstriktör bir ajan olan serotoninin no-reflow fenomeni gelişimi üzerine olan etkisini araştırmaktı. Yöntemler: Bu enine-kesitli kontrollü çalışmaya akut miyokart enfarktüsü nedeniyle, göğüs ağrılarının ilk 12 saati içinde kliniğimize başvuran ve primer perkütan girişim uygulanan 40 hasta alındı. İşlem öncesi akım TIMI 0 iken işlem sonrası akım normal olanlar grup 1'i, işlem sonrası akım TIMI ≤2 olanlar grup 2'yi oluşturdu. Serotonin düzeyini ölçmek için işlem öncesi koroner ostiumdan kan alındı. Bulgular: Grup 1'de 25 hasta (20 erkek, 5 kadın) vardı, ortalama yaş 58±11 yıl idi; Grup 2' de 15 hasta vardı (13 erkek, 2 kadın) ve ortalama yaş 62±8 yıl idi. Grup'1 de trombosit içi ortalama serotonin düzeyi 476±208 ng/10 9 trombosit ve grup 2'de 542±273 ng/10 9 trombosit idi. Fark istatistiksel olarak anlamlı değildi (p=0.39). Serum serotonin düzeyi grup'1 de 41.4±40.8 ng/ml, grup'2 de 66.7±45.7 ng/ml olarak bulundu. Aradaki fark anlamlı değildi (p=0.07). Relationship between no-reflow phenomenon and serotonin levels in patients with acute ST-elevation myocardial infarction who underwent primary percutaneous intervention Akut ST yükselmeli miyokart enfarktüsü nedeniyle primer perkütan girişim uygulanan hastalarda no-reflow fenomeni ile serotonin düzeyi arasındaki ilişki

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“…19) Although adenosine has a beneficial effect on noreflow, the mechanism of this effect is not known. A study, designed to test glycoprotein IIb/ IIIa receptor inhibitors, showed that intracoronary injection of this agent resulted in TIMI III flow in 2 of 3 patients with no-reflow phenomenon during AMI 20) and that no-reflow phenomenon can be prevented by performing predilatation before stent deployment.…”

Section: Discussionmentioning

confidence: 99%

Treatment of No-Reflow Phenomenon with Verapamil after Primary Stent Deployment during Myocardial Infarction.

et al. 2002

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SUMMARYNo-reflow phenomenon is the absence of myocardial perfusion despite adequate dilatation of the infarct related coronary artery during percutaneous coronary intervention. It predicts severe left ventricular dysfunction and poor prognosis in acute myocardial infarction (AMI). The present case is a 54 year old Turkish female who presented with chest pain that had started 2.5 hours earlier. The clinical and laboratory findings were consistent with AMI and the coronary angiogram performed for primary angioplasty revealed a 95% thrombotic occlusion with a TIMI grade I flow in the left anterior descending (LAD) coronary artery. A TIMI grade III flow was achieved with direct stent deployment. However, after the placement of a second stent for severe ostial stenosis more proximally and adjacent to the first one, the antegrade flow became TIMI grade O. As the intracoronary medications did not improve the flow, a mechanical occlusion was considered and a third stent was deployed covering the first two stents. A control angiogram revealed the persistence of TIMI grade O flow. A severe and persistent vasospasm was considered at this point and accordingly, intracoronary verapamil was administered in high concentrations by an infusion catheter to the distal LAD which was followed by the immediate achievement of TIMI grade III flow. Intracoronary administration of high dose verapamil can be performed to prevent vasospasm in resistant no-reflow cases with no evidence of mechanic occlusion. ( and is known to prevent ischaemic myocardial dysfunction.2) However, some studies have showed the absence of expected functional recovery in the left ventricle, despite normal flow in the epicardial coronary artery.3) The 'no-reflow' phenomenon is the absence of myocardial perfusion, despite adequate dilatation of the responsible artery, without a dissection, mechanic obstruction, or distal emboli. 4,5) The 'no-reflow' phenomenon can be detected by angiography, 3) scinFrom

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Direct coronary stenting without balloon predilation in acute coronary syndromes

Cited by 66 publications

References 22 publications

Effectiveness of Thrombectomy Before Stent Implantation in Acute Myocardial Infarction

Effectiveness of Thrombectomy Before Stent Implantation in Acute Myocardial Infarction

Relationship between no-reflow phenomenon and serotonin levels in patients with acute ST-elevation myocardial infarction who underwent primary percutaneous intervention

Treatment of No-Reflow Phenomenon with Verapamil after Primary Stent Deployment during Myocardial Infarction.

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