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Effect of intracoronary nicorandil administration on preventing no-reflow/slow flow phenomenon during rotational
Akiyoshi Tsubokawa1, Kinzo Ueda, Hiroki Sakamoto
1Department of Cardiovascular Medicine, Takeda General Hospital, Kyoto, Japan. takedadr@mbox.kyoto-inet.or.jp
Abstract:
A major limitation of the rotational atherectomy (RA) procedure is the occurrence of the no-reflow/slow flow phenomenon and the optimal strategy is still evolving. Recent clinical studies have demonstrated the beneficial effects of nicorandil, an adenosine triphosphate (ATP)-sensitive potassium channel opener, on no-reflow in patients with acute myocardial infarction. The purpose of this study was to evaluate the effect of nicorandil on no-reflow/slow flow phenomenon during RA procedures. Sixty-one patients who underwent RA of complex coronary lesions were randomly divided into 2 groups: (i) nicorandil cocktail (n=24 patients, 37 lesions) and (ii) verapamil cocktail (n=37 patients, 63 lesions). In each group, the drug cocktail mixed with pressurized saline was infused through the 4Fr Teflon sheath of the rotablator system during the RA procedure. In the nicorandil group, the drug cocktail consisted of 24 mg of nicorandil, 5 mg of nitroglycerin, and 10,000 U of heparin. In the verapamil group, the drug cocktail consisted of 10 mg of verapamil, 5 mg of nitroglycerin, and 10,000 U of heparin. Baseline and procedure characteristics did not differ between the 2 groups. RA was performed successfully, and death, Q-wave myocardial infarction, or emergency coronary artery bypass surgery did not occur in any patients. The no-reflow/slow flow phenomenon was observed in 11/63 (17.4%) lesions of the verapamil group, but in only 1/37 (2.7%) lesions of the nicorandil group (p=0.03). No untoward complications were observed during nicorandil infusion. These data indicate that the intracoronary continuous infusion of nicorandil during RA procedures is easy and safe, and prevents no-reflow/slow flow phenomenon more effectively than infusion of verapamil.
Insights
Nicorandil effectively prevents no-reflow/slow flow during rotational atherectomy (RA). This adenosine triphosphate-sensitive potassium channel opener is a safe and superior alternative to verapamil for managing this RA complication.
Area of Science:
- Cardiology
- Interventional Cardiology
- Pharmacology
Background:
- Rotational atherectomy (RA) is limited by the no-reflow/slow flow phenomenon.
- Optimal strategies for preventing no-reflow during RA are still evolving.
- Nicorandil, an ATP-sensitive potassium channel opener, shows promise in managing no-reflow.
Purpose of the Study:
- To evaluate the efficacy and safety of nicorandil in preventing no-reflow/slow flow during RA.
- To compare nicorandil with verapamil for managing no-reflow during RA.
Main Methods:
- A randomized study involving 61 patients undergoing RA for complex coronary lesions.
- Patients were assigned to receive either a nicorandil or verapamil cocktail infused via the rotablator system.
- Drug cocktails included nitroglycerin and heparin; verapamil was used as a comparator.
Main Results:
- The no-reflow/slow flow phenomenon occurred in 17.4% of verapamil group lesions versus 2.7% in the nicorandil group (p=0.03).
- RA was successful in all patients, with no deaths, Q-wave myocardial infarctions, or emergency bypass surgeries.
- Nicorandil infusion was associated with no adverse complications.
Conclusions:
- Intracoronary nicorandil infusion during RA is a safe and effective method to prevent no-reflow/slow flow.
- Nicorandil demonstrates superior efficacy compared to verapamil in mitigating this procedural complication.
- Nicorandil represents a promising therapeutic option for enhancing RA safety and outcomes.
