TY - JOUR
T1 - Adenosine use during aortocoronary vein graft interventions reverses but does not prevent the slow-no reflow phenomenon
AU - Sdringola, S.
AU - Assali, A.
AU - Ghani, M.
AU - Yepes, A.
AU - Rosales, O.
AU - Schroth, George
AU - Fujise, Ken
AU - Anderson, H. V.
AU - Smalling, R. W.
PY - 2000/12/14
Y1 - 2000/12/14
N2 - 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 μg 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 μg of intra-graft adenosine. (C) 2000 Wiley-Liss, Inc.
AB - 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 μg 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 μg of intra-graft adenosine. (C) 2000 Wiley-Liss, Inc.
KW - Adenosine
KW - No-reflow
KW - Saphenous vein graft
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U2 - 10.1002/1522-726X(200012)51:4<394::AID-CCD4>3.0.CO;2-G
DO - 10.1002/1522-726X(200012)51:4<394::AID-CCD4>3.0.CO;2-G
M3 - Article
C2 - 11108667
AN - SCOPUS:0033662285
VL - 51
SP - 394
EP - 399
JO - Catheterization and Cardiovascular Interventions
JF - Catheterization and Cardiovascular Interventions
SN - 1522-1946
IS - 4
ER -