Rapid reversal of no-reflow using abciximab after coronary device intervention

Rawitscher, David; Levin, Thomas N.; Cohen, Ian D.; Feldman, Ted

doi:10.1002/(sici)1097-0304(199710)42:2<187::aid-ccd20>3.0.co;2-k

Cited by 54 publications

(19 citation statements)

References 13 publications

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“…The traumatic instability of the atheroma induced by therapeutic maneuvers leads to an increase in platelet adhesiveness followed by a state of activation and increase in aggregation, resulting in the formation of white thrombi and vascular occlusion. This theory is supported by results of researchers, 14 who demonstrated the reversal of established "no-reflow" by using the inhibitor of the glycoprotein IIb/IIIa of the platelets.…”

supporting

confidence: 52%

“…Platelet action hypothesis -Rawitscher and co-workers 14 consider that platelets also actively participate in the "no-reflow" phenomenon. The traumatic instability of the atheroma induced by therapeutic maneuvers leads to an increase in platelet adhesiveness followed by a state of activation and increase in aggregation, resulting in the formation of white thrombi and vascular occlusion.…”

mentioning

confidence: 99%

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The "no-reflow" phenomenon in the coronary arteries

A¹,

Dp²,

Ee³

1999

Arq. Bras. Cardiol.

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supporting

confidence: 52%

mentioning

confidence: 99%

The "no-reflow" phenomenon in the coronary arteries

A¹,

Dp²,

Ee³

1999

Arq. Bras. Cardiol.

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“…10, 14 In addition, the role of abciximab in reversal of the no-reflow and slow-flow phenomena during coronary intervention was also documented. 15 Beneficial effects of coronary stenting during rescue PTCA compared to plain balloon PTCA have recently been reported. 16 In this study, we observed an additional benefit of abciximab in improving the angiographic result and reducing the incidences of slow-flow and reocclusion.…”

Section: Discussionmentioning

confidence: 99%

Abciximab during Rescue Angioplasty after Failed Thrombolysis

Kaul

Sapra

Sudan

et al. 2001

Asian Cardiovasc Thorac Ann

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Abciximab (a glycoprotein IIb/IIIa inhibitor) was assessed in 16 of 36 patients with acute myocardial infarction who were referred for rescue angioplasty after failed thrombolysis. Baseline clinical and angiographic characteristics were comparable in the abciximab and non-abciximab groups. Coronary stenting was carried out in all patients in the non-abciximab group and in 13 in the abciximab group. Angiographic success was achieved in all patients. Persistence of slow flow was encountered more frequently in the non-abciximab group (30% versus 6.25%, p < 0.05). Stent thrombosis occurred in 2 patients (10%) who were successfully redilated and there was one case of bleeding requiring transfusion in the non-abciximab group; neither of these complications occurred in the abciximab group. Predischarge left ventricular ejection fraction was better in the abciximab group (44% ± 3% versus 36% ± 3%, p < 0.01). All patients were discharged alive and were asymptomatic at the one-month follow-up. Use of abciximab during angioplasty after failed thrombolysis improved angiographic and clinical results without increasing the risk of bleeding, and reduced the incidence of in-hospital complications. Larger studies are warranted to confirm this important observation.

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“…There are only anecdotal reports showing the bene t of this agent when used as a bail-out measure after occurrence of slow ow phenomenon during coronary intervention. 11 This has important therapeutic implications, especially in centres where abciximab is not routinely administered in all high-risk interventions because of the signi cant economic implications, the drug being very expensive and often costing more than the stent and balloon catheter taken together.…”

Section: Discussionmentioning

confidence: 99%

Reversal of slow flow phenomenon during primary stenting by bail-out administration of abciximab

Kaul

Sapra²,

Sudan³

et al. 2000

International Journal of Cardiovascular Interventions

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BACKGROUND: Slow flow or no reflow phenomenon is increasingly being recognized as a serious problem during coronary angioplasty and stenting. This phenomenon is seen more often during angioplasty in highly thrombogenic milieux, especially in a setting of acute myocardial infarction. The treatment of this complication is often not satisfactory. In this study the authors assessed the efficacy of abciximab, a potent antiplatelet drug, in treating slow flow or no reflow phenomenon during primary percutaneous transluminal coronary angioplasty (PTCA) for acute myocardial infarction (AMI). METHODS: Twenty-one instances of persistent slow flow phenomenon were encountered in 131 consecutive patients subjected to primary PTCA for AMI (16%). It was more common in patients presenting with AMI complicated by cardiogenic shock (nine of 21, 43%). Of these 21 cases of slow flow, 10 patients were given injection abciximab during the procedure of primary PTCA as a bail-out measure after encountering the complication of slow flow or no reflow. A pre-discharge coronary angiography was carried out in all patients who survived. RESULTS: In seven of 10 patients in the abciximab group flow had improved to TIMI-3. In contrast, in the non-abciximab group TIMI flow improved in only four of 11 patients. Patients with persistent slow flow had significantly higher mortality at the first 30-day follow-up than patients with TIMI-3 flow (33% versus 1.8%, p<0.001). CONCLUSION: In this small nonrandomized study significant improvement in coronary flow was achieved by using intravenous abciximab after observing slow flow or no reflow phenomenon during primary PTCA. More frequent use of this drug in this milieu might help in preventing the development of this complication. Larger studies are warranted to confirm this life-saving beneficial effect of bail-out administration of abciximab during primary angioplasty.

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Rapid reversal of no-reflow using abciximab after coronary device intervention

Cited by 54 publications

References 13 publications

The "no-reflow" phenomenon in the coronary arteries

The "no-reflow" phenomenon in the coronary arteries

Abciximab during Rescue Angioplasty after Failed Thrombolysis

Reversal of slow flow phenomenon during primary stenting by bail-out administration of abciximab

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