Distal coronary artery perfusion during percutaneous transluminal coronary angioplasty.
Perfusion of the coronary artery distal to an occluding angioplasty balloon was performed in 34 patients undergoing coronary angioplasty (PTCA). A randomized crossover study was employed using two exogenous substances as perfusates: lactated Ringer's solution (LR) and a fluorocarbon emulsion (FL), Fluosol-DA 20%. Both substances are electrolyte solutions, but the FL will dissolve more oxygen than the LR. During two attempted coronary artery occlusions of 90 seconds each, we perfused through the central lumen (guidewire channel) of the PTCA catheter at 60 ml/min. With FL perfusion the mean time to onset of angina after occlusion was delayed (41 +/- 21 vs 33 +/- 16 seconds, mean +/- SD; p less than 0.05), the mean duration of angina was shortened (77 +/- 58 vs 92 +/- 70 seconds, p less than 0.05), and the rise in the ST segment of the ECG was reduced (0.15 +/- 0.24 vs 0.2 +/- 0.23 mV, p less than 0.001) when compared to LR perfusion. Balloon occlusion time was able to be extended with FL perfusion (71 +/- 22 vs 59 +/- 22 seconds p less than 0.001). These results indicate that perfusion of the distal coronary artery is possible during PTCA and can reduce ischemia during a prolonged balloon occlusion time.
Anderson
H V
HV
Leimgruber
P P
PP
Roubin
G S
GS
Nelson
D L
DL
Gruentzig
A R
AR
D000328:Adult; D000368:Aged; D000787:Angina Pectoris / Q000503:physiopathology; D000800:Angioplasty, Balloon; D001157:Arterial Occlusive Diseases / Q000503:physiopathology / Q000628:therapy; D001802:Blood Substitutes; D003327:Coronary Disease / Q000503:physiopathology / Q000628:therapy*; D004338:Drug Combinations / Q000627:therapeutic use; D004562:Electrocardiography; D005260:Female; D005466:Fluorocarbons / Q000627:therapeutic use; D006439:Hemodynamics; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives; D007552:Isotonic Solutions / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010477:Perfusion; D011669:Pulmonary Wedge Pressure; D011897:Random Allocation; D000077325:Ringer's Lactate; D013997:Time Factors
D001802:Blood Substitutes; D004338:Drug Combinations; D005466:Fluorocarbons; D006895:Hydroxyethyl Starch Derivatives; D007552:Isotonic Solutions; D000077325:Ringer's Lactate; C017323:glucose, glycerol, hydroxyethyl starch, perfluorodecalin, perfluorotripropylamine, pluronic F-68, salts, yolk phospholipids drug combination