Protection of the ischemic myocardium during percutaneous transluminal coronary angioplasty.
Therapeutic balloon coronary angioplasty provides a useful model for studying the effects of epicardial coronary artery occlusion in conscious humans. In addition, it is a potent model in which the effectiveness of interventions designed to ameliorate ischemia can be evaluated. Whereas intravenous beta-adrenergic blocking drugs and nitrates appear to have a limited protective effect, the regional (i.e., intracoronary) use of beta-adrenergic blocking drugs and calcium antagonists seem more potent. Currently, coronary venous retroperfusion with arterial blood does not appear practical, and the intraaortic balloon is a useful adjunctive measure in relatively few patients undergoing percutaneous transluminal coronary angioplasty. In contrast, the direct anterograde delivery of oxygen-rich blood or fluorocarbons holds promise as a reliable means of providing local myocardial protection. If ischemia could be markedly reduced, percutaneous transluminal coronary angioplasty might be applied safely in more high-risk clinical settings. In addition, if prolonged balloon inflation could be performed, there might be an increase in primary success rate and possibly a reduction in restenosis rate.
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000800:Angioplasty, Balloon; D001769:Blood; D001802:Blood Substitutes / Q000627:therapeutic use; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D003327:Coronary Disease / Q000628:therapy*; D003331:Coronary Vessels; D004338:Drug Combinations / Q000627:therapeutic use; D004452:Echocardiography; D004562:Electrocardiography; D005466:Fluorocarbons / Q000627:therapeutic use; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives; D007423:Intra-Aortic Balloon Pumping; D007430:Intraoperative Care; D010477:Perfusion; D014665:Vasodilator Agents / Q000627:therapeutic use
D000319:Adrenergic beta-Antagonists; D001802:Blood Substitutes; D002121:Calcium Channel Blockers; D004338:Drug Combinations; D005466:Fluorocarbons; D006895:Hydroxyethyl Starch Derivatives; D014665:Vasodilator Agents; C017323:glucose, glycerol, hydroxyethyl starch, perfluorodecalin, perfluorotripropylamine, pluronic F-68, salts, yolk phospholipids drug combination