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Slow reflow

Qiang Su, Lang Li, Jinmin Zhao, Yuhan Sun, Huafeng Yang
Coronary microembolization (CME) is a common complication of percutaneous coronary intervention (PCI) for acute coronary syndrome. It leads to myocardial apoptosis and cardiac dysfunction. Nicorandil pretreatment can prevent PCI-related myocardial injury and reduce the incidence of no- or slow-reflow phenomena. This cardioprotective effect is probably attributable to the suppression of CME-induced cardiomyocyte apoptosis, but the specific mechanisms have not been clarified. We aimed to investigate the protective effects of nicorandil pretreatment on CME-induced myocardial injury and clarify the underlying mechanisms...
November 21, 2017: Oncotarget
Xian-Tao Wang, Xiao-Dan Wu, Yuan-Xi Lu, Yu-Han Sun, Han-Hua Zhu, Jia-Bao Liang, Wen-Kai He, Zhi-Yu Zeng, Lang Li
BACKGROUND/AIMS: Coronary microembolization (CME) can lead to no-reflow or slow reflow, which is one of the important reasons for loss of clinical benefit from myocardial reperfusion therapy. MicroRNAs and autophagy are heavily implicated in the occurrence and development of almost all cardiovascular diseases. Therefore, the present study was designed to investigate the role of miR-30e-3p and autophagy in CME-induced myocardial injury rat model. METHODS: Sixty rats were randomly divided into six groups: sham, CME 1h,3h,6h,9h, and 12h (n = 10 per group)...
December 11, 2017: Cellular Physiology and Biochemistry
Ahmed N Mahmoud, Marwan Saad, Akram Y Elgendy, Amgad Mentias, Islam Y Elgendy
OBJECTIVES: To perform a meta-analysis of randomized trials comparing a deferred versus immediate stenting strategy for primary percutaneous coronary intervention (PCI). BACKGROUND: Deferred stent implantation has emerged as a potential strategy aiming to reduce the thrombus burden and improve micro-vascular reperfusion during primary PCI. METHODS: Electronic databases were searched for randomized trials that compared a deferred stent implantation versus immediate stent implantation strategy in patients undergoing primary PCI...
August 11, 2017: Catheterization and Cardiovascular Interventions
Ziad A Ali, Todd J Brinton, Jonathan M Hill, Akiko Maehara, Mitsuaki Matsumura, Keyvan Karimi Galougahi, Uday Illindala, Matthias Götberg, Robert Whitbourn, Nicolas Van Mieghem, Ian T Meredith, Carlo Di Mario, Jean Fajadet
OBJECTIVES: This study sought to determine the mechanistic effects of a novel balloon-based lithoplasty system on heavily calcified coronary lesions and subsequent stent placement using optical coherence tomography (OCT). BACKGROUND: The Shockwave Coronary Rx Lithoplasty System (Shockwave Medical, Fremont, California) delivers localized, lithotripsy-enhanced disruption of calcium within the target lesion (i.e., lithoplasty) for vessel preparation before stent implantation...
August 2017: JACC. Cardiovascular Imaging
Riccardo Liga, Enrico Orsini, Paolo Caravelli, Marco De Carlo, Anna Sonia Petronio, Mario Marzilli
Reciprocal ST-segment downsloping on electrocardiogram is a frequent finding during ST-elevated myocardial infarction (STEMI), but its etiology is still disputed. We sought to evaluate the relation between reciprocal ST-segment downsloping during STEMI and major cardiac perfusion and functional parameters. One hundred eighty-five patients with STEMI underwent emergency coronary angiography. The presence of reciprocal ST-segment downsloping was assessed. At coronary angiography, the corrected TIMI frame count (cTFC) was computed both on culprit and remote vessels and the occurrence of "no/slow reflow" phenomenon after percutaneous coronary intervention (PCI) identified...
June 15, 2017: American Journal of Cardiology
Jianzhong Qiao, Lingxin Pan, Bin Zhang, Jie Wang, Yongyan Zhao, Ru Yang, Huiling Du, Jie Jiang, Conghai Jin, Enlai Xiong
BACKGROUND: A number of studies have evaluated the efficacy of deferred stenting vs immediate stenting in patients with ST-segment elevation myocardial infarction, but the findings were not consistent across these studies. This meta-analysis aims to assess optimal treatment strategies in patient with ST-segment elevation myocardial infarction. METHODS AND RESULTS: We searched the PubMed, EMBASE, and the Cochrane Library for studies that assessed deferred vs immediate stenting in patients with ST-segment elevation myocardial infarction...
March 8, 2017: Journal of the American Heart Association
Sining Hu, Yinchun Zhu, Yingying Zhang, Jiannan Dai, Lulu Li, Harold Dauerman, Tsunenari Soeda, Zhao Wang, Hang Lee, Chao Wang, Chunyang Zhe, Yan Wang, Gonghui Zheng, Shaosong Zhang, Haibo Jia, Bo Yu, Ik-Kyung Jang
BACKGROUND: Plaque rupture and erosion are the 2 most common mechanisms for acute coronary syndromes. However, the outcome of these 2 distinct pathologies in patients with acute coronary syndromes has never been studied. METHODS AND RESULTS: We retrospectively studied 141 patients with acute coronary syndromes who underwent optical coherence tomography (OCT) imaging of the culprit lesion prior to stenting from the Massachusetts General Hospital OCT Registry. Management (stent versus no stent), poststent OCT findings, and outcomes were compared...
February 24, 2017: Journal of the American Heart Association
Z Q Wang, M X Chen, D L Liu, W X Zheng, X Z Cao, H Chen, M F Huang, Z R Luo
Objective: To investigate the effect of intracoronary administration of nicorandil prior to primary percutaneous coronary intervention (PPCI) on myocardial perfusion and short-term clinical outcomes in patients with ST-segment elevation myocardial infarction (STEMI). Methods: A total of 158 patients with STEMI undergoing PPCI from January 2014 to December 2015 in Fuzhou General Hospital were enrolled consecutively in this prospective controlled randomized trial. Patients were assigned into three groups with random number table: the nicorandil group (patients received intracoronary administration of 6 mg nicorandil after guide wire or balloon successfully crossed the target lesion, n=53), the nitroglycerin group (patients received intracoronary administration of 300 μg nitroglycerin after after guide wire or balloon successfully crossed the target lesion, n=52) and the control group(patients received routine treatment, n=53)...
January 25, 2017: Zhonghua Xin Xue Guan Bing za Zhi
Joo Myung Lee, Tae-Min Rhee, Haseong Chang, Chul Ahn, Taek Kyu Park, Jeong Hoon Yang, Young Bin Song, Seung-Hyuk Choi, Hyeon-Cheol Gwon, Joo-Yong Hahn
BACKGROUND: We sought to evaluate safety and efficacy of the deferred stenting versus immediate stent implantation of infarct-related arteries in patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). METHODS: A meta-analysis using random-effects models were conducted. The primary outcome, major adverse cardiac events (MACE), was a composite of all-cause mortality, myocardial infarction (MI), any unplanned target vessel revascularization (TVR), and hospitalization due to cardiac cause...
March 1, 2017: International Journal of Cardiology
Lorenzo Azzalini, Rustem Dautov, Soledad Ojeda, Antonio Serra, Susanna Benincasa, Barbara Bellini, Francesco Giannini, Jorge Chavarría, Livia L Gheorghe, Manuel Pan, Mauro Carlino, Antonio Colombo, Stéphane Rinfret
OBJECTIVES: To study the long-term outcomes of rotational atherectomy (RA) for chronic total occlusion (CTO) percutaneous coronary intervention (PCI). BACKGROUND: There is little evidence on the incidence, procedural results and long-term outcomes of RA for CTO PCI. METHODS: This registry included data from consecutive patients undergoing CTO PCI at four specialized centers. Major adverse cardiac events (MACE: cardiac death, target-vessel myocardial infarction and ischemia-driven target-vessel revascularization) on follow-up were the primary endpoint...
April 2017: Catheterization and Cardiovascular Interventions
Mikkel M Schoos, Roxana Mehran, George D Dangas, Jennifer Yu, Usman Baber, Peter Clemmensen, Frederick Feit, Bernard J Gersh, Giulio Guagliumi, E Magnus Ohman, Stuart J Pocock, Bernhard Witzenbichler, Gregg W Stone
Women are frequently reported to have increased morbidity after presentation with acute coronary syndromes and myocardial infarction; however, whether a greater thrombotic tendency contributes to gender differences in clinical outcomes of urgent percutaneous coronary intervention is unknown. Intraprocedural Thrombotic Events (IPTEs) are defined as new or increasing thrombus, abrupt vessel closure, no reflow or slow reflow, or distal embolization at any time during percutaneous coronary intervention. IPTEs were evaluated in this pooled analysis of 6,591 patients with stent implantation and blinded quantitative coronary angiography (QCA) analysis, from the ACUITY and HORIZONS-AMI trials...
December 1, 2016: American Journal of Cardiology
Lu Gao, Zhenhua Cao, Hong Zhang
BACKGROUND No/slow reflow gives rise to serious complications in STEMI patients undergoing PCI, and can lead to worse outcomes. Several measures are used to prevent no/slow reflow, including thrombus removal processes and intensive use of anticoagulant agents. Our study was designed to evaluate the efficacy and safety of thrombectomy and intracoronary administration of GPIIb/IIIa inhibitors in STEMI patients undergoing PPCI. MATERIAL AND METHODS We randomly assigned 240 STEMI patients into 3 groups. Before PPCI, patients in group A received thrombectomy and intracoronary administration of tirofiban...
July 31, 2016: Medical Science Monitor: International Medical Journal of Experimental and Clinical Research
Lixia Yang, Lihua Mu, Linhui Sun, Feng Qi, Ruiwei Guo
BACKGROUND: The no/slow reflow phenomenon during primary percutaneous coronary intervention (PPCI) causes the destruction of the coronary microcirculation and further myocardial damage. Some studies have shown that intracoronary nitroprusside infusion is a safe and effective method for managing the no/slow reflow phenomenon. However, it is uncertain whether the injection of nitroprusside at a specific time point during PPCI can most effectively prevent no-reflow. In this study, we investigated the effect of the timing of an intracoronary nitroprusside injection on flow recovery during PPCI in patients with ST elevation acute myocardial infarction (STEMI)...
April 2017: Minerva Cardioangiologica
Wei-Chieh Lee, Shyh-Ming Chen, Chu-Feng Liu, Chien-Jen Chen, Wen-Jung Chung, Shu-Kai Hsueh, Tzu-Hsien Tsai, Hsiu-Yu Fang, Hon-Kan Yip, Chi-Ling Hang
BACKGROUND: Intracoronary nitroprusside and thrombus aspiration have been demonstrated to improve myocardial perfusion during percutaneous coronary interventions (PCI) for ST-segment elevation acute myocardial infarction (STEMI) However, no long-term clinical studies have been performed comparing these approaches. METHODS: A single medical center retrospective study was conducted to evaluate the effects of intracoronary nitroprusside administration before slow/no-reflow phenomena versus thrombus aspiration during primary PCI...
September 2015: Acta Cardiologica Sinica
Ruofei Jia, Xiaolu Nie, Hong Li, Huagang Zhu, Lianmei Pu, Xiang Li, Jing Han, Duo Yang, Shuai Meng, Zening Jin
BACKGROUND: Plaques with a large necrotic core or lipid pool and thin-cap fibroatheroma manifest as attenuated plaques on intravascular ultrasound (IVUS). Their impact on TIMI grade flow and clinical outcomes remains undefined. We performed a systematic review and meta-analysis to summarize the association between attenuated plaque and distal embolization and clinical outcomes of coronary artery disease (CAD) from pooled data of published eligible cohort studies. METHODS: We searched the literature on TIMI grade flow and clinical outcomes on PubMed, Ovid, EMBASE, the Cochrane Library, CNKI and WanFang databases...
March 2016: Journal of Thoracic Disease
Michael S Lee, Evan Shlofmitz, Richard Shlofmitz, Sheila Sahni, Brad Martinsen, Jeffrey Chambers
OBJECTIVES: The ORBIT II trial reported excellent outcomes in patients with severely calcified coronary lesions treated with orbital atherectomy. Severe calcification of the left main (LM) artery represents a complex coronary lesion subset. This study evaluated the safety and efficacy of coronary orbital atherectomy to prepare severely calcified protected LM artery lesions for stent placement. METHODS: The ORBIT II trial was a prospective, multicenter clinical trial that enrolled 443 patients with severely calcified coronary lesions in the United States...
September 2016: Journal of Invasive Cardiology
Jeffrey D Wessler, Philippe Généreux, Roxana Mehran, Girma Minalu Ayele, Sorin J Brener, Margaret McEntegart, Ori Ben-Yehuda, Gregg W Stone, Ajay J Kirtane
OBJECTIVES: This study sought to determine the extent to which individual components of intraprocedural thrombotic events (IPTEs) are associated with adverse events. BACKGROUND: IPTEs occurring during percutaneous coronary intervention (PCI) are associated with adverse in-hospital and late outcomes in patients with acute coronary syndromes. METHODS: A total of 6,591 patients who underwent PCI for non-ST-segment elevation acute coronary syndromes/ST-segment elevation myocardial infarction in the ACUITY (Acute Catheterization and Urgent Intervention Triage StrategY) and HORIZONS-AMI (Harmonizing Outcomes with RevascularIZatiON and Stents in Acute Myocardial Infarction) trials underwent detailed frame-by-frame core laboratory angiographic analysis to assess for IPTEs...
February 22, 2016: JACC. Cardiovascular Interventions
Brahim Harbaoui, Pierre-Yves Courand, Cyril Besnard, Raphael Dauphin, Emmanuel Cassar, Pierre Lantelme
BACKGROUND: Slow flow, no reflow and distal embolization often occur during primary angioplasty in ST segment elevation myocardial infarction (STEMI), compromising optimal myocardial reperfusion. AIMS: This study aimed at assessing the impact of deferred stenting (DS) on periprocedural events as compared to immediate stenting (IS). The second objective was to gather the reasons advocated by the physicians for deferring stenting. METHODS: All consecutive patients referred for primary angioplasty were included between September 2010 and November 2011...
November 2015: La Presse Médicale
Seifollah Abdi, Omid Rafizadeh, Mohammadmehdi Peighambari, Hoseinali Basiri, Hooman Bakhshandeh
BACKGROUND: The no-reflow phenomenon is an uncommon and critical occurrence which myocardial reperfusion does not restore to its optimal level. Several predisposing factors of the no-reflow phenomenon have been identified. However, at present we know little about clinical predictors of no-reflow after percutaneous coronary intervention (PCI). OBJECTIVES: In this study, we evaluated clinical predictors of no-reflow phenomenon after PCI in patients with acute STEMI, to plan a better treatment of these patients...
May 2015: Research in Cardiovascular Medicine
Enrico Cerrato, Cristina Rolfo, Francesco Tomassini, Nicolò Montali, Alfonso Gambino, Vincenzo Infantino, Sara Palacio Restrepo, Denise Baricocchi, Rosa Nevola, Andrea Gagnor, Ferdinando Varbella
BACKGROUND: The MGuard (MG) is a stainless-steel closed cell stent covered with an ultra-thin polymer mesh sleeve, which has the purpose of ensuring reduced distal embolization of thrombotic material, thus lowering the risk of no-reflow/slow-flow phenomena. Only few data are available that evaluated the usefulness of the MG stent in patients with ST-elevation myocardial infarction (STEMI) with a high thrombotic burden. METHODS: We prospectively collected data of patients presenting with STEMI and high thrombotic burden (thrombus burden grade 4 or 5 according to the TIMI score) who underwent primary percutaneous coronary intervention (PCI) with MG stent implantation in our center...
June 2015: Giornale Italiano di Cardiologia
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