Document Detail

Adenosine use during aortocoronary vein graft interventions reverses but does not prevent the slow-no reflow phenomenon.
MedLine Citation:
PMID:  11108667     Owner:  NLM     Status:  MEDLINE    
Slow or no reflow (SNR) complicates 10-15% of cases of percutaneous intervention (PI) in saphenous vein bypass graft (SVG). To date there have been limited options for the prevention and treatment of this common and potentially serious complication. We evaluated the procedural outcome of 143 consecutive SVG interventions. We compared patients who received pre-intervention intra-graft adenosine boluses with those who did not. In addition we examined the efficacy of adenosine boluses to reverse slow-no reflow events. Angiograms were reviewed and flow graded (TIMI grade) by film readers blinded to the use of any intraprocedural drug or clinical history. Seventy patients received intragraft adenosine boluses before percutaneous intervention (APPI), 73 received no preintervention adenosine (NoAPPI). There were no significant angiographic differences between the two groups at baseline. A total of 20 patients experienced SNR. The incidence of SNR was similar in the two groups (APPI = 14.2% vs. NoAPPI = 13.6%, P = 0.9). SNR was treated with repeated, rapid boluses (24 microg each) of intra-graft adenosine. Reversal of SNR was observed in 10 of 11 patients (91%) who received high doses of adenosine (>/=5 boluses, mean 7.7 +/- 2.6) and in 3 of 9 (33%) of those who received low doses (<5 boluses, mean 1.5 +/- 1.2). Final TIMI flow was significantly better in the high dose than in the low dose group (final TIMI 2.7 +/- 0.6 vs. 2 +/- 0.8, P = 0.04). No significant untoward complications were observed during adenosine infusion. These findings suggest that SNR after PI in SVG is not prevented by pre-intervention adenosine, but it can be safely and effectively reversed by delivery of multiple, rapid and repeated boluses of 24 microg of intra-graft adenosine.
S Sdringola; A Assali; M Ghani; A Yepes; O Rosales; G W Schroth; K Fujise; H V Anderson; R W Smalling
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions     Volume:  51     ISSN:  1522-1946     ISO Abbreviation:  Catheter Cardiovasc Interv     Publication Date:  2000 Dec 
Date Detail:
Created Date:  2000-12-26     Completed Date:  2001-01-18     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  100884139     Medline TA:  Catheter Cardiovasc Interv     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  394-9     Citation Subset:  IM    
Department of Medicine, Division of Cardiology, University of Texas-Houston Medical School, Houston, Texas, USA.
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MeSH Terms
Adenosine / therapeutic use*
Coronary Artery Bypass*
Coronary Circulation*
Middle Aged
Postoperative Complications / prevention & control*
Prospective Studies
Regional Blood Flow
Retrospective Studies
Saphenous Vein / transplantation*
Treatment Outcome
Vasodilator Agents / therapeutic use*
Reg. No./Substance:
0/Vasodilator Agents; 58-61-7/Adenosine
Comment In:
Catheter Cardiovasc Interv. 2001 Oct;54(2):267-8   [PMID:  11590698 ]
Catheter Cardiovasc Interv. 2000 Dec;51(4):400-1   [PMID:  11108668 ]

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