Treatment of no-reflow in degenerated saphenous vein graft interventions: Comparison of intracoronary verapamil and nitroglycerin

✍ Scribed by Kaplan, Barry M. ;Benzuly, Keith H. ;Kinn, James W. ;Bowers, Terry R. ;Tilli, Frank V. ;Grines, Cindy L. ;O'Neill, William W. ;Safian, Robert D.

• Publisher: John Wiley and Sons
• Year: 1996
• Tongue: English
• Weight: 490 KB
• Volume: 39
• Category: Article
• ISSN: 0098-6569
• DOI: 10.1002/(sici)1097-0304(199610)39:2<113::aid-ccd1>3.0.co;2-i

✦ Synopsis

No-reflow has been repo~ed after 1&15% of percutaneous interventlons on degenerated saphenous veln grafts. in this prospective study of 36 degenerated saphenous veln graft lesions (32 patlents), no-reflow (TIMI flow <3 in the absence of a significant lesion or dissectlon) occurred in 15/36 (42%) leslons. A total of 32 episodes of no-refiow occurred after angloscopy (n = 14), extractlon atherectomy (n = lo), balloon angioplasty (n = 2) or stent lmpiantatlon (n = 6). lntragraft nitroglycerin (100-300 pg) alone resulted In no Improvement in TlYi flow In the setting of no-refiow (TIMI flow 1.2 f 0.6 to 1.4 f 0.8, P = NS). intragraft verapamll(100-500 pg) resulted In Improvement In flow In ail 32 eplsodes (TIMI flow 1.4 f 0.8 before, to 2.8 f 0.5 after verapamil, P < 0.001). Although verapamil Increased TIMI flow after all episodes of no-reflow, two (6.3%) had persistent no-refiow (TIMI 1) desplte verapamil, associated with non-Q wave myocardlal infarction. In conciusion, treatment of no-refiow with verapamll durlng degenerated veln graft interventions was assoclated with reestablishment of TIMI 3 flow in 88% of cases. In contrast, lntragraft nitroglycerin alone was Ineffective for reversing no-refiow.