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Published on: February 3, 2021
Comparison of intracoronary adenosine and isosorbide dinitrate on no-reflow/slow flow during rotational atherectomy
Tien-Ping Tsao1, Shu-Meng Cheng, Cheng-Chung Cheng
1Division of Cardiology, Department of Internal Medicine, Tri-Service General Hospital, National Defence Medical Centre, Taiwan, Republic of China.
Insights
Intracoronary adenosine and isosorbide dinitrate (ISDN) are safe for use during high-speed rotational atherectomy (HSRA) in complex coronary artery disease (CAD). Both agents may help reduce no-reflow/slow flow complications.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- Complex coronary artery disease (CAD) poses challenges during interventions like high-speed rotational atherectomy (HSRA).
- No-reflow/slow flow phenomenon is a potential complication during HSRA, impacting procedural outcomes.
- Intracoronary vasodilators are explored to mitigate this complication.
Purpose of the Study:
- To compare the efficacy of intracoronary adenosine and isosorbide dinitrate (ISDN) in preventing no-reflow/slow flow during HSRA.
- To assess the safety and procedural success rates associated with these agents in complex CAD patients.
Main Methods:
- Retrospective analysis of medical records from patients with complex CAD undergoing HSRA.
- Patients received either intracoronary adenosine (50 microg) or ISDN (0.5 mg) bolus.
- Outcomes including angiographic success, procedural success, and no-reflow/slow flow incidence were recorded.
Main Results:
- Angiographic success was high in both groups (100% adenosine vs. 98.3% ISDN).
- Procedural success rates were 96.9% for adenosine and 89.7% for ISDN.
- No-reflow/slow flow occurred in 3.1% of the adenosine group versus 10.3% of the ISDN group (P=0.414).
Conclusions:
- Intracoronary adenosine and ISDN administration during HSRA is safe.
- Both agents show potential in reducing the incidence of no-reflow/slow flow.
- Larger, prospective, randomized, placebo-controlled trials are needed to confirm these findings.
Objective:
To compare the effect of intracoronary adenosine and isosorbide dinitrate (ISDN) on no-reflow/slow flow during high-speed rotational atherectomy (HSRA) in patients with complex coronary artery disease (CAD).
Methods And Results:
Medical records from consecutive patients diagnosed with complex CAD between November 2002 and March 2006 who underwent HSRA at the Tri-Service General Hospital, National Defence Medical Centre in Taipei, Taiwan, were included in this study. Patients in the adenosine group (n=32) received a 50 microg intracoronary adenosine bolus prior to the initiation of burr rotation and during each ablation. Patients in the ISDN group (n=58) received a 0.5 mg intracoronary ISDN bolus at comparable time points. Angiographic success was achieved in 100% of patients in the adenosine group and 98.3% (57/58) in the ISDN group.The procedural success rates were 96.9% (31/32) in the adenosine group and 89.7% (52/58) in the ISDN group. One patient (3.1%) from the adenosine group and six patients (10.3%) from the ISDN group experienced no-reflow/slow flow (P = 0.414). No in-hospital mortality occurred and target vessel revascularization was unnecessary.
Conclusions:
Intracoronary administration of either adenosine or ISDN during HSRA appears safe and administration of either agent may be effective in decreasing the incidence of no-reflow/slow flow during HSRA. Further large, prospective, randomized, placebo-controlled trials are required.
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