Read and React
- 41-year old female with resistant hypertension and obstructive sleep apnea
- MVD and primary PCI: which strategy?
- 'The Great Debate' - Dual antiplatelet therapy - Which drug? For which patient? For which stent? For how long?
- 'The Great Debate' - Diffuse Coronary artery disease - Available options? New strategies on the Horizon? How to best optimise the options?
- Is what you see really what you get?
- FFR assessment of coronary stenoses in series
- Home
- |
- Lectures
- |
- AsiaPCR/SingLIVE 2012 Case Corner
- |
- Intracoronary adrenaline for resistant Noreflow during PCI in acute coronary...
Intracoronary adrenaline for resistant Noreflow during PCI in acute coronary syndrome
- Main session: Interactive Case Corner: share your experience!
- Speaker: Samir WAFA
-
Classification:
Coronary interventions
- Clinical presentation: Stemi
- Specific "risks" subset: Diabetes , Depressed left ventricular function
- Anatomy subset: Single vessel disease
- Sub anatomy subset: Thrombus containing lesion
- Vascular access: Femoral
- Complication: No complication
DEJAN JOVIC 04.24.2012
Please explain effects of IC adrenalin on no reflow?
Pawel Krzywicki 05.10.2012
As Dejan Novic I would be most interested in rationale and pathophysiological explanation of this.
As for the procedure, I would rather pre-treat the lesion with abciximab and postpone the ballooning and stenting since the flow is estabilished.
It would also be prudent to try a shot of intracoronary thrombolysis.
In such cases, stenting is a ”final touch”.
As with many affairs in medicine, the best way of treating no-reflow is its prevention.
samir wafa 05.11.2012
Thank you for your comments. The exact mechanism of adrenaline on no reflow is not well known, but I think it is due to its vasodilator effect on the microvascar bed.
In retrospect I think that in case of heavy thrombus burden you have to do three things, first thrombus aspiration class II a, second GP II a/ III b whether IC or IV class II a, third is injection of IC adenosine, verapamil class IIb in ESC guidelines and II a in ACC/ AHA guidelines or nitroprusside class II a in ACC/ AHA guidelines or other drugs that are. Of yet inthe guidelines but promising like adrenaline, nicorandil, nicardipine, diltiazem or endothelin antagonists. All should be given through microcatheter to be more effective on the distal vascular bed with less side effects.
Hansmartin Jetter 05.14.2012
thanks for this case. Wich dosage of adrenaline did you use.
HmJ
celin malkun 05.14.2012
Thanks, what's the dosage IC?
friedoon naraghipour 07.07.2012
wich dosage?
Nalin Patel 09.28.2012
What was the BP at peak slow flow / no reflow? Often a low perfusion pressure is associated with slow flow, and maybe the adrenalin improved blood presure and hence perfusion
Hugo Chinchilla 10.07.2012
Tuve recientemente un caso similar, paciente de 40 años de edad con sobrepeso y exfumador, quien me fue remitido con IAM de cara anterior con 4 dias despues del evento agudo ( Ignorancia del cardiologo general) es remitido en situacion de Shock Cardiogenico, se le administran drogas inotropicas y se reliza angiografia coronaria diagnostica evidenciandose lesion 100% tercio proximal antes de la 1 diagonal con flujo TIMII 0. Procedo a atravesar lesion con guia cougar de medtronic e inflar balon 2.5 x 20 mm evidenciandose minimamnete la luz del vaso pero se apreciaba lesion distal severa, en tercio medio severa y proximal severa. se colocan en cada lesion sten endeavour de medtronic y presentando no reflujo por lo que administre inmediatamnet vearapamil intracoronario en 2 ocasiones y continuaba sin mejorar el flujo, por lo que decido administrar adenosina intracoronaria en 2 ocasiones presentando al final flujo TIMI III y mejoria hemodinamica. Mi pegunta es que dosis utilizaron de adrenalina?
Jose Delgado 10.13.2012
I would like yo Know the dose usted?
Thank's.
Van Hoang 10.14.2012
What is the BP before using adrenalin?
which is the dosage ?