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Published on: May 28, 2019
Clinical applications of coronary sinus retroperfusion during high risk percutaneous transluminal coronary
R L Incorvati1, S G Tauberg, M J Pecora
1Department of Medicine, Allegheny General Hospital, Medical College of Pennsylvania, Pittsburgh.
Insights
Synchronized coronary sinus retroperfusion of arterial blood effectively reduced myocardial ischemia during high-risk coronary angioplasty. This technique improved wall motion abnormalities without increasing ST segment deviation, supporting its use in cardiac interventions.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiovascular Physiology
Background:
- Coronary sinus retroperfusion (CSR) has shown promise in supporting ischemic heart muscle.
- Previous studies in animals and humans indicate CSR's efficacy in myocardial protection.
Purpose of the Study:
- To evaluate the effectiveness of synchronized coronary sinus retroperfusion of arterial blood.
- To determine if CSR reduces myocardial ischemia during high-risk coronary angioplasty.
Main Methods:
- Twenty-one patients undergoing high-risk coronary angioplasty were randomized.
- CSR support was provided during angioplasty balloon inflations.
- Myocardial ischemia was assessed using echocardiography, ST segment deviation, and hemodynamic variables.
Main Results:
- CSR significantly reduced left anterior descending wall motion abnormalities (p < 0.05).
- No additional ST segment deviation was observed despite longer supported inflations (p < 0.004).
- Coronary sinus pressures were significantly higher during CSR (p < 0.001).
Conclusions:
- CSR effectively reduces myocardial ischemia, evidenced by improved wall motion during angioplasty.
- CSR does not exacerbate ischemic changes on ECG, even with prolonged support.
- The technique offers a promising adjunct for high-risk coronary angioplasty procedures.
Objectives:
This study was designed to determine the efficacy of synchronized coronary sinus retroperfusion of arterial blood in reducing myocardial ischemia associated with the performance of high risk coronary angioplasty.
Background:
Previous animal and clinical work has demonstrated the efficacy of this technique in supporting ischemic myocardium.
Methods:
Twenty-one patients were randomized to alternately receive coronary sinus retroperfusion support during either the second or the third coronary angioplasty balloon inflation, after an initial unsupported brief control inflation. Myocardial ischemia was assessed by the extent of echocardiographic left ventricular wall motion abnormality, quantified ST segment deviation and hemodynamic and anginal variables during balloon inflations performed with and without coronary sinus retroperfusion support. Regional wall motion score was defined as hyperkinesia (-1), normokinesia (0), hypokinesia (+1), akinesia (+2) and dyskinesia (+3).
Results:
A reduction in the echocardiographic left anterior descending regional wall motion score in retroperfusion-supported (1.7 +/- 2.1) versus unsupported (2.7 +/- 1.6) inflations (p < 0.05) was noted. Twelve-lead electrocardiographic monitoring revealed no additional ST segment deviation during supported (173 +/- 95 s) compared with unsupported (129 +/- 87 s) angioplasty inflations despite a significantly longer duration of supported inflations (p < 0.004). Mean and peak systolic coronary sinus pressures differed during supported inflations (21 +/- 6 and 44 +/- 13 mm Hg) versus unsupported inflations (10 +/- 4 and 16 +/- 5 mm Hg) (p < 0.001). There was no difference in hemodynamic or anginal variables.
Conclusions:
A reduction in ischemia as defined by wall motion abnormality during retroperfusion-supported compared with unsupported angioplasty balloon inflations was documented. No additional ST segment deviation occurred during retroperfusion-supported compared with unsupported balloon inflations despite a significantly longer duration of supported inflations. No difference in hemodynamic or anginal variables was noted.
