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2018, Number 1

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Rev Sanid Milit Mex 2018; 72 (1)

Utility of the intracoronary angiography with microcatheter to avoid no reflow phenomenon in primary angioplasty

Gutiérrez LH, Valenzuela HJC, Galván VCG, Chávez OJA, Iñarra TF

Language: Spanish
References: 28
Page: 32-39
PDF size: 281.83 Kb.


ABSTRACT

Introduction: The acute coronary occlusion associated with a high valuation of morbimortalidad in the acute infarction of the myocardium with elevation of the ST segment (STEMI), represents a challenge for the interventionist, due the unknown amount of thrombus load and its characteristics beyond the occlusion (microvascular obstruction (MVO), distal stenosis), which leads to complicate the primary angioplasty (PTCA) and to the no reflow phenomenon (NFP), which has an overall incidence reported from 20 to 40%. Objectives: To evaluate the efficacy of the distal coronary angiography with microcatheter, that leads to an individualized therapeutic strategy, with the purpose of prevent the NFP in the accute coronary occlusion in STEMI treated with PTCA. Material and methods: 70 patients were included with STEMI. We performed coronary angiography with microcatheter distal to the obstruction, and the therapeutic strategy was chosen in accordance with findings: stenosis, thrombus amount or MVO. After the PTCA were performed, we evaluated the NFP incidence. Results: Report of 70 patients, the majority men (80%), class Killip Kimbal I (95 %), with disease of the right coronary artery in 57%, and anterior descending coronary artery in 37%. Distal thrombus was present in 47% of the studied patients. An obstruction length of more than 30 mm was observed in 21% of the cases, also we observed dissection of the arteries in a 21%, MVO was presented in 41%, and distal stenosis in 25%. Used therapeutic strategies: It was applied medicated stent in 81% of the patients, long balloon in 93%, and thrombolytic therapy in 30%. We observed a NFP incidence of 18.6 %. Conclusions: The diagnostic and therapeutic approach for STEMI that this study recommends, diminishes the NFP in comparison with reported. An obstruction › 30 mm is an independent factor for NFP, therefore in these cases we recommend use the described diagnostic approach and long balloon.


REFERENCES

  1. García-Castillo A, Jerjes-Sánchez C, Martínez-Bermúdez P, Azpiri-López J, Autrey-Caballero A, Martínez-Sánchez C y cols. Registro Mexicano de síndromes coronarios agudos (RENASICA II). Arch Cardiol. 2005; 75 (1): 6-18.

  2. Steg G, James SK, Atar D, Badano LP, Blomstrom LC, Borger MA, di Mario C y cols. Guía de práctica clínica de la ESC para el manejo del infarto agudo de miocardio en pacientes con elevación del segmento ST. Rev Esp Cardiol. 2013; 66 (1): 53.e1-e46.

  3. Jaffe R, Dick A, Strauss BH. Prevention and treatment of microvascular obstruction-related myocardial injury and coronary no-reflow following percutaneous coronary intervention. JACC Cardiovasc Interv. 2010; 3 (7): 695-704.

  4. Antman EM, Anbe DT, Armstrong PW, Bates ER, Green LA, Hand M et al. ACC/AHA Guidelines for the management of patients wit ST elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task for the practice guidelines (Committee to Revise the 1999 Guidelines for the Management of patients with acute Myocardial Infarction). Circulation. 2004; 110 (9): e82-e292.

  5. Mallet AL, Oliveira GM, Klein CH, Carvalho MR, Souza e Silva NA. In-hospital mortality and complications after coronary angioplasty, City of Rio de Janeiro, Southeastern Brazil. Rev Saude Pública. 2009; 43 (6): 917-927.

  6. Chang-Bum Park, Jin-Man Cho, Dong-Hee Kim, Chong-Jin Kim. Intracoronary nitroglycerin injection through a microcatheter for coronary no- reflow following percutaneous coronary intervention. Int J Car. 2016; 214: 400-402.

  7. Hamm CW, Bassand JP, Agewall S, Bax J, Boersma E, Bueno H et al. ESC Guidelines for the management of acute coronary syndromes in patients presenting with persistent ST segment elevation. European Heart Journal. SC 2011; 32 (23): 2999-3054.

  8. Gara PT, Kushner FG, Ascheim DD, Casey DE Jr, Chung MK, De Lemos JA et al. 2013 ACCF/AHA Guideline for the management of ST-elevation myocardial infarction. JACC. 2013; 61 (4): e78-e140.

  9. Ingo E, Friedrich MG. T2-weighted cardiovascular magnetic resonance in acute cardiac disease. Journal of Cardiovascular Magnetic Resonance. 2011; 13: 13.

  10. Verhaert D, Thavendiranathan P, Giri S, Mihai G, Rajagopalan S, Simonetti OP et al. Direct T2 quantification of myocardial edema in acute ischemic injury. JACC Cardiovasc Imaging. 2011; 4 (3): 269-278.

  11. Irwin RS, Rippe JM. Manual of intensive care medicine. 5th ed. Philadelphia: Lippincott Williams & Wilkins; 2010. p. 332.

  12. Van Gaal WJ, Banning AP. Percutaneous coronary intervention and the no reflow phenomenon. Expert Rev Cardiovasc Ther. 2007; 5 (4): 715-731.

  13. Steg G, James SK, Atar D, Badano LP, Blomstrom LC, Borger MA, Di Mario K et al. ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. European Heart Journal. 2012; 33 (20): 2569-2619.

  14. Monteleone PP, Yeh RW. Management of complications. Int Car Cli. 2016; 5 (2): 201-209.

  15. Kern MJ, Sorajja P, Lim M. The Cardiac Catheterization Handbook. 6th edition. Elsevier; 2016. pp. 419-459. ISBN; 978-0-323-34039-7.

  16. Francone M, Bucciarelli-Ducci C, Carbone I, Canali E, Scardala R, Calabrese FA et al. Impact of primary coronary angioplasty delay on myocardial salvage, infarct size, and microvascular damage in patients with ST-segment elevation myocardial infarction: insight from cardiovascular magnetic resonance. J Am Coll Cardiol. 2009; 54 (23): 2145-2153.

  17. Cakici M, Cetin M, Balli M, Akturk E, Dogan A, Oylumlu M et al. Predictors of trombus burden and no reflowof infacrtc artery in ST segmengt level myocardial infarction: importance of platetelet index. Blood Coagulation and Fibrinolysis. International Journal in Haemostasis and Thrombosis. 2014; 25 (7): 709-715.

  18. Piraino D, Assennato P. Coronary artery perforation: how to treat it? Cor et Vasa. 2015; 57 (5): e334-e340.

  19. Sang Yup Lim. No-reflow phoenomenon by intracoronary thrombus in acute myocardial infarction. Chonnam Med J. 2016; 52 (1): 38-44.

  20. Jaffe R, Charron T, Puley G, Dick A, Strauss BH. Microvascular obstruction and the no-reflow phenomenon after percutaneous coronary intervention. Circulation. 2008; 117 (24): 3152-3156.

  21. Kelly RV, Cohen MG, Stouffer GA. Incidence and management of “no-reflow” following percutaneous coronary interventions. Am J Med Sci. 2005; 329 (2): 78-85.

  22. Ross AM, Gibbons RJ, Stone GW, Kloner RA, Alexander RW; AMISTAD-II Investigators. A randomized, double-blinded, placebo-controlled multicenter trial of adenosine as an adjunct to reperfusion in the treatment of acute myocardial infarction (AMISTAD-II). J Am Coll Cardiol. 2005; 45 (11): 1775-1780.

  23. Maioli M, Bellandi F, Leoncini M, Toso A, Dabizzi RP. Randomized early versus late abciximab in acute myocardial infarction treated with primary coronary intervention (RELAx-AMI trial). J Am Coll Cardiol. 2007; 49 (14): 1517-1524.

  24. Van’t Hof AW, Ten Berg J, Heestermans T, Dill T, Funck RC, van Werkum W et al. Prehospital initiation of tirofiban in patients with ST-elevation myocardial infarction undergoing primary angioplasty (On-TIME 2): a multicentre, double-blind, randomised controlled trial. Lancet. 2008; 372 (9638): 537-546.

  25. Tcheng JE, Kandzari DE, Grines CL, Cox DA, Effron MB, Garcia E et al. Benefits and risks of abciximab use in primary angioplasty for acute myocardial infarction (CADILLAC). Circulation. 2003; 108 (11): 1316-1323.

  26. Burzotta F, Trani C, Romagnoli E, Mazzari MA, Rebuzzi AG, De Vita M et al. Manual thrombus-aspiration improves myocardial reperfusion: the randomized evaluation of the effect of mechanical reduction of distal embolization by thrombus-aspiration in primary and rescue angioplasty (REMEDIA) trial. J Am Coll Cardiol. 2005; 46 (2): 371-376.

  27. Silva-Orrego P, Colombo P, Bigi R, Gregori D, Delgado A, Salvade P et al. Thrombus aspiration before primary angioplasty improves myocardial reperfusion in acute myocardial infarction: the DEAR-MI (dethrombosis to enhance acute reperfusion in myocardial infarction) study. J Am Coll Cardiol. 2006; 48 (8): 1552-1559.

  28. Gruberg L. EMERALD: enhanced myocardial efficacy and removal by aspiration of liberated debris. American College of Cardiology Annual Metting. Medscape, 2004.




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