Haemodynamic and antiarrhythmic protective effects of intracoronary perfusion during percutaneous transluminal coronary angioplasty

Area of Science:

• Cardiovascular Research
• Interventional Cardiology
• Physiology

Background:

• Percutaneous transluminal coronary angioplasty (PTCA) involves balloon inflation, which can compromise myocardial blood flow.
• The risk of ischemia and arrhythmias, including ventricular fibrillation (VF), increases during balloon inflation.
• Strategies to mitigate ischemia during PTCA are crucial for patient outcomes.

Purpose of the Study:

• To investigate the potential myocardial protective effects of intracoronary perfusion during PTCA balloon inflation.
• To assess the impact of perfusion on hemodynamic status and the incidence of VF.
• To compare the efficacy and safety of whole blood versus diluted blood for perfusion.

Main Methods:

• Experiments were conducted on 17 anesthetized open-chest pigs.
• A dilatation catheter was used for balloon inflation in the left anterior descending coronary artery.
• Intracoronary perfusion was administered during balloon inflation using whole blood or diluted blood (25% hematocrit).
• Hemodynamic parameters and occurrence of VF were monitored.

Main Results:

• Balloon inflation alone, without perfusion, led to significant hemodynamic deterioration and VF in 4/14 cases.
• Simultaneous intracoronary perfusion during balloon inflation prevented hemodynamic decline and improved parameters compared to baseline.
• No instances of VF occurred when perfusion was applied during balloon inflation.
• Diluted blood perfusion prevented intracatheter thrombus formation, a complication observed with whole blood perfusion.

Conclusions:

• Intracoronary perfusion through a dilatation catheter during PTCA provides significant myocardial protection.
• This technique effectively prevents hemodynamic deterioration and life-threatening arrhythmias like VF.
• Perfusion with diluted blood is a safe and effective alternative, avoiding thrombus formation.