Myocardial protection during coronary angioplasty with an autoperfusion balloon catheter in humans.

Abstract

An autoperfusion balloon catheter was developed to allow passive myocardial perfusion during inflation through a central lumen and multiple side holes in the shaft proximal and distal to the balloon. We report its safety and efficacy in 11 patients undergoing elective angioplasty to a single coronary lesion. Each lesion was dilated three times with the autoperfusion inflation bracketed between two inflations by standard angioplasty catheters. Chest pain score, 12-lead electrocardiogram, heart rate, and mean aortic pressure were recorded before each inflation and at 1-minute intervals after inflation. Inflation duration during autoperfusion angioplasty (513+± 303 seconds) was longer than for the pre-(107+±-55 seconds, p=0.0004) and post-(139+± 71 seconds, p=0.0006) standard dilatations. The maximum ST-segment elevation and depression in any lead during autoperfusion angioplasty (0.3 0.5 and 0.6 0.8 mm) was significantly less than for the pre-(2.4± 1.7 mm, p=0.002 and 2.2± 1.3 mm, p=0.0004) or post-(1.9 + 1.3 mm, p = 0.002 and 1.6±+1.3 mm, p= 0.018) standard dilatations at the same point in time. Maximal chest pain score during autoperfusion (3.2-+ 3.5) was lower than for the pre-(6.1 2. 1, p=0.003) but not the post-(5.2 3.1, p=0.07) standard angioplasty. All 11 patients underwent successful, uncomplicated procedures. We conclude that this autoperfusion catheter significantly reduces ischemic symptoms and signs during coronary angioplasty, allowing prolonged periods of balloon inflation. (Circulation 1988;78:1128-1134 M a aximum duration of balloon inflation during conventional percutaneous transluminal coronary angioplasty is usually short (30-60 seconds) because it is limited by the development of symptoms and signs of myocardial ischemia. Theoretical advantages of more prolonged inflation periods, for which there is some experimental and clinical support, include improved initial angiographic results and lower restenosis rates.1-3 Autoperfusion balloon catheters, which allow continued passive myocardial perfusion during periods of balloon inflation, provide us with the means potentially to achieve this goal. Previous studies with similar catheters have demonstated adequate From the Interventional Cardiac Catheterization Program,

New concept in coronary angioplasty: Dilatation with a helical balloon that allows simultaneous autoperfusion

“…7). Clearly, myocardial perfusion and reduction of ischemia, both of which have been amply demonstrated to occur with the Erbel-type catheter [2][3][4], are preferable to the absence of antegrade coronary flow that occurs during standard balloon inflations. However, the requirement for a large lumen and the retraction and replacement of the guidewire during procedures performed with conventional perfusion devices are limitations that may, in part, explain why these catheters are not used in favor of nonperfusion devices.…”

“…Autoperfusion catheters are available and have been clearly shown to limit myocardial ischemia during bal-loon inflation [2][3][4]. The limitation of ischemia can reduce the risk of complex angioplasty.…”

“…Improvements in overall catheter profile, to enhance performance characteristics, therefore result in diminished perfusion. The profile of these catheters and the need to retract the guidewire for optimum flow [3] may, in part, explain the overall preference for nonperfusion catheters in the majority of angioplasty procedures.…”

Distal coronary hemoperfusion during percutaneous transluminal coronary angioplasty

“…Ischemia reduction during perfusion balloon angioplasty in patients. Several studies have documented ischemia reduction during perfusion balloon angioplasty compared to standard angioplasty [19][20][21]. During perfusion balloon angioplasty, there was a reduction of angina and ST-segment abnormalities as well as an improved echocardiographic wall motion score.…”

Novel perfusion sleeve for use during balloon angioplasty: Initial clinical experience

“…Perfusion of blood to distal myocardium during balloon inflations has been shown to reduce ischemia and to allow for prolonged balloon inflations [1]. Prolonged inflations have been used to treat the complications of PTCA, such as acute closure and dissection, as well as to improve initial angiographic outcome [2][3][4][5].…”