Document Detail


Treatment of no-reflow in degenerated saphenous vein graft interventions: comparison of intracoronary verapamil and nitroglycerin.
MedLine Citation:
PMID:  8922307     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
No-flow has been reported after 10-15% of percutaneous interventions on degenerated saphenous vein grafts. In this prospective study of 36 degenerated saphenous vein graft lesions (32 patients), no-flow (TIMI flow < 3 in the absence of a significant lesion or dissection) occurred in 15/36 (42%) lesions. A total of 32 episodes of no-flow occurred after angioscopy (n = 14), extraction atherectomy (n = 10), balloon angioplasty (n = 2) or stent implantation (n = 6). Intragraft nitroglycerin (100-300 micrograms) alone resulted in no improvement in TIMI flow in the setting of no-reflow (TIMI flow 1.2 +/- 0.6 to 1.4 +/- 0.8, P = NS). Intragraft verapamil (100-500 micrograms) resulted in improvement in flow in all 32 episodes (TIMI flow 1.4 +/- 0.8 before, to 2.8 +/- 0.5 after verapamil, P < 0.001). Although verapamil increased TIMI flow after all episodes of no-reflow, two (6.3%) had persistent no-reflow (TIMI 1) despite verapamil, associated with non-Q wave myocardial infarction. In conclusion, treatment of no-reflow with verapamil during degenerated vein graft interventions was associated with reestablishment of TIMI 3 flow in 88% of cases. In contrast, intragraft nitroglycerin alone was ineffective for reversing no-reflow.
Authors:
B M Kaplan; K H Benzuly; J W Kinn; T R Bowers; F V Tilli; C L Grines; W W O'Neill; R D Safian
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Catheterization and cardiovascular diagnosis     Volume:  39     ISSN:  0098-6569     ISO Abbreviation:  Cathet Cardiovasc Diagn     Publication Date:  1996 Oct 
Date Detail:
Created Date:  1997-02-26     Completed Date:  1997-02-26     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  7508512     Medline TA:  Cathet Cardiovasc Diagn     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  113-8     Citation Subset:  IM    
Affiliation:
Division of Cardiology (Department of Internal Medicine), William Beaumont Hospital, Royal Oak, Michigan 48073, USA.
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MeSH Terms
Descriptor/Qualifier:
Aged
Calcium Channel Blockers* / administration & dosage,  therapeutic use
Coronary Angiography
Coronary Artery Bypass / adverse effects*
Female
Graft Occlusion, Vascular / drug therapy*,  etiology,  radiography
Graft Survival / drug effects
Humans
Injections, Intra-Arterial
Male
Middle Aged
Nitroglycerin*
Prognosis
Prospective Studies
Regional Blood Flow / physiology
Saphenous Vein / physiology*
Vasodilator Agents* / administration & dosage,  therapeutic use
Verapamil* / administration & dosage,  therapeutic use
Chemical
Reg. No./Substance:
0/Calcium Channel Blockers; 0/Vasodilator Agents; 52-53-9/Verapamil; 55-63-0/Nitroglycerin
Comments/Corrections
Comment In:
Cathet Cardiovasc Diagn. 1996 Oct;39(2):119   [PMID:  8922308 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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