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Intracoronary Hemodynamic Effects of Pressure-Controlled Intermittent Coronary Sinus Occlusion (PICSO): Results from the First-In-Man Prepare PICSO Study.
MedLine Citation:
PMID:  22994798     Owner:  NLM     Status:  Publisher    
Background : Myocardial reperfusion is frequently suboptimal after ST-segment elevation myocardial infarction (STEMI) treated by primary percutaneous coronary intervention (PCI). Using a balloon-tipped catheter positioned in the coronary sinus (CS), pressure-controlled intermittent coronary sinus occlusion (PICSO) results in an intermittent obstruction of coronary venous outflow of the left anterior descending artery (LAD), and may improve myocardial perfusion by augmenting redistribution of blood to the border zone of ischemic myocardium. We sought to document the intracoronary hemodynamic effects of PICSO during PCI. Methods : We included 15 patients with stable angina scheduled for PCI of the LAD. Balloon occlusion of the LAD was performed twice, once with and once without PICSO and lasting maximally 3 minutes each, to document the effect of PICSO on CS pressure and LAD wedge pressure. Results : Catheter delivery was successful in all patients. The study protocol could not be conducted in 5 patients due to initial calibration difficulties (n = 3), a pressure wire problem (n = 1), and a vagal response at the start of the procedure (n = 1). In the remaining 10 patients, CS occlusion caused a marked increase in mean CS pressure (4.1 ± 7.3 mmHg vs. 22.0 ± 12.6 mmHg; P < 0.001) and CS pulse pressure (4.3 ± 0.8 mmHg vs. 36.1 ± 6.3 mmHg; P < 0.001). Concomitantly, mean distal LAD wedge pressure and wedge pulse pressure increased (32.4 ± 12.2 mmHg vs. 35.5 ± 12.6 mmHg; P < 0.001 and 39.1 ± 27.2 mmHg vs. 45.9 ± 26.0 mmHg; P < 0.001, respectively). At 30 day follow-up, no device-related events occurred. Conclusions : PICSO safely augments CS pressure, thereby increasing LAD coronary wedge pressure. These findings support further evaluation of PICSO in the setting of STEMI. (J Interven Cardiol 2012;**:1-8).
Tim P VAN DE Hoef; Froukje Nolte; Ronak Delewi; Jose P S Henriques; Jos A E Spaan; Jan G P Tijssen; Maria Siebes; Joanna J Wykrzykowska; Gregg W Stone; Jan J Piek
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-9-20
Journal Detail:
Title:  Journal of interventional cardiology     Volume:  -     ISSN:  1540-8183     ISO Abbreviation:  J Interv Cardiol     Publication Date:  2012 Sep 
Date Detail:
Created Date:  2012-9-21     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8907826     Medline TA:  J Interv Cardiol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
©2012, Wiley Periodicals, Inc.
Department of Cardiology Department of Biomedical Engineering and Physics, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands Columbia University Medical Center, New York City, NY.
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