Initial coronary occlusion improves tolerance to subsequent prolonged balloon inflations

Heibig, Jacques; Bolli, Roberto; Harris, Scott L.

doi:10.1002/ccd.1810160206

Cited by 27 publications

(7 citation statements)

References 7 publications

(8 reference statements)

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“…An 8-french guiding catheter (USCI) was positioned into the coronary ostium and an appropriately sized 'steerable-balloon dilation catheter (USCI) posi tioned through the guiding catheter across the stenotic lesion. In all patients, angioplasty was performed by three or more balloon infla tions (3)(4)(5)(6)(7)(8)4.3 ± 1.8 times) for 90 s. Initially, balloon inflation was repeated three times with pressures of 6, 8 and 10 atm. The angio plasty was concluded when optimal dilation was obtained.…”

Section: Ethodsmentioning

confidence: 99%

“…However, per cutaneous transluminal coronary angioplasty (PTCA) serves as a useful model in the study of the clinical, elec- trocardiographic, systemic and coronary hemodynamic and myocardial metabolic responses to controlled coro nary-artery occlusion. Some reports describe evidence of adaptation to ischemia during PTCA [4][5][6], However, the greatest interest in this 'ischemic preconditioning' is in its mechanism. In the present study, we investigated, clini cally.…”

Section: Introductionmentioning

confidence: 99%

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A Mechanism of Ischemic Preconditioning during Percutaneous Transluminal Coronary Angioplasty

Inoue

Fujito²,

Hoshi³

et al. 1996

Cardiology

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Manifestation of ischemic preconditioning and its mechanisms during percutaneous transluminal coronary angioplasty (PTCA) was evaluated. Twenty-two patients with angina pectoris, who had one-vessel coronary artery disease of the proximal left anterior descending artery but without visual collateral circulation, underwent elective PTCA performed by balloon inflations of 90 s, repeated three times or more. Changes in standard 12-lead electrocardiogram, hemodynamics and oxygen saturation of the great cardiac vein by a fiber-optic catheter were analyzed. Anginal chest pain occurred in 21 patients (95%) during the first balloon inflation, and in only 9 patients (41%) during the third inflation. In comparison with the first inflation, the third produced less shifts in ST junction (p < 0.01) and peak T (p < 0.01), which were measured and averaged by 4 chest leads from V₂ to V₅. The heart rate-blood pressure product during the third inflation was equivalent to that during the first. The great cardiac vein oxygen saturation decreased equally during the first and third inflations. However, the ratio of the saturation at reactive hyperemia after balloon deflation to baseline was higher (p < 0.01) in the third than in the first inflation. The adenosine content of the great cardiac vein measured in 11 patients just prior to balloon deflation was also higher (p < 0.05) in the third inflation than the value in the first. Repeated coronary artery occlusion during PTCA could cause ischemic preconditioning, which may be derived from mechanisms common to accelerated reactive hyperemia, for example an increase in intrinsic adenosine levels.

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Section: Ethodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A Mechanism of Ischemic Preconditioning during Percutaneous Transluminal Coronary Angioplasty

Inoue

Fujito²,

Hoshi³

et al. 1996

Cardiology

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“…Indirect evidence that preconditioning can occur in man derives from studies of indirect markers of regional ischemia during coronary angioplasty balloon inflations (BIs) [1,2,3,4,5,6,7]. The bulk of the evidence supporting preconditioning in man has been derived from studies of the electrocardiographic consequences of repeated BIs during coronary angioplasty.…”

Section: Introductionmentioning

confidence: 99%

“…A number of confounding factors may contribute to confusion over preconditioning of the human myocardium during coronary angioplasty. Firstly, it is clear that in a number of positive reports, there may have been recruitment of additional collateral flow to the ischemic zone following the initial BI [2, 6]. Secondly, in the majority of studies, the duration of the BIs ranged from 30 to 120 s; however, studies in rabbits suggest that at least 120 s of ischemia may be necessary to initiate preconditioning [8].…”

Section: Introductionmentioning

confidence: 99%

“…Deutsch et al [1] reported that ST segment shift, venous lactate production and chest pain were all reduced during the second of 2 sequential 90-second BIs. Since then, a number of studies using a variety of electrophysiological, metabolic and contractile endpoints claim to have demonstrated increased ischemic tolerance with repeated coronary occlusions during coronary angioplasty [2,3,4,5,6,7]. …”

Section: Introductionmentioning

confidence: 99%

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Repeated Balloon Inflations Do Not Diminish ST Segment Elevation even though Coronary Collateral Recruitment Is Promoted in Pigs

Lyras

Papalois²,

Klamargias³

et al. 2007

Cardiology

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Objective: Attempts to demonstrate preconditioning during repeated angioplasty balloon inflations (BIs) have not been universally successful. The main obstacle is that the first BI is unreliable, due to the variable degrees of occlusion by the deflated balloon. In the present study, we examined whether ST segment elevation decreases and evaluated its relation to collateral recruitment during repeated angioplasty BIs in the pig. Methods and Results: Twenty male pigs, 7 months old, under general anesthesia, underwent 3 repeated BIs of 120 s, with a 5-min interval between them, in the left anterior descending artery or the right coronary artery. A pressure wave wire was used for the measurement of coronary wedge pressure and to obtain the intracoronary ST segment elevation. Intracoronary ST segment elevation was 1.97 ± 0.76 mV during the 1st BI, 2.09 ± 0.82 mV during the 2nd BI and 1.84 ± 0.82 mV during the 3rd BI (p = n.s.). Coronary wedge pressure was 12 ± 6, 18 ± 18 and 20 ± 20 mm Hg (p < 0.05 vs. 1st BI) during the 3 BIs, respectively. Conclusion: Repeated BIs do not diminish ST segment elevation in the pig model, even though coronary collateral recruitment is promoted.

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Is Preconditioning Relevant to Clinical Medicine?

Kloner¹,

Przyklenk²

1994

Developments in Cardiovascular Medicine

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Initial coronary occlusion improves tolerance to subsequent prolonged balloon inflations

Cited by 27 publications

References 7 publications

A Mechanism of Ischemic Preconditioning during Percutaneous Transluminal Coronary Angioplasty

A Mechanism of Ischemic Preconditioning during Percutaneous Transluminal Coronary Angioplasty

Repeated Balloon Inflations Do Not Diminish ST Segment Elevation even though Coronary Collateral Recruitment Is Promoted in Pigs

Is Preconditioning Relevant to Clinical Medicine?

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