Local delivery of heparin post-PTCA: A multicenter randomized pilot study

✍ Scribed by Jean-François Tanguay; Warren J. Cantor; Mitchell W. Krucoff; Brent Muhlestein; Gregory W. Barsness; James P. Zidar; Michael H. Sketch Jr.; James E. Tcheng; Harry R. Phillips; Richard S. Stack; Aaron V. Kaplan; E. Magnus Ohman

• Publisher: John Wiley and Sons
• Year: 2000
• Tongue: English
• Weight: 63 KB
• Volume: 49
• Category: Article
• ISSN: 1522-1946
• DOI: 10.1002/(sici)1522-726x(200004)49:4<461::aid-ccd26>3.0.co;2-7

✦ Synopsis

Bailout stenting for major dissection and threatened closure has high rates of ischemic complications. We performed a randomized trial of local heparin delivery using the infusion sleeve before bailout stenting for suboptimal angioplasty results. In phase I, 20 patients were randomized to local delivery with either 40-or 100-psi infusion pressure. In phase II, 37 patients were randomized to local delivery at 100 psi or standard therapy. Local delivery succeeded in all but one patient; overall there was no significant worsening of intimal dissection. One patient treated with 100-psi drug infusion suffered a perforation after stent placement. There were no significant differences in the composite endpoint of death, MI, CABG, urgent repeat angioplasty, and stent thrombosis at 30 days (21% vs. 0%; P ‫؍‬ 0.18). At 6 months, the rates of myocardial infarction in phase II were 27% with local delivery vs. 10% with standard treatment (P ‫؍‬ 0.4). Local heparin delivery in dissected vessels may be associated with increased complications and should be approached with caution.