Treatment of no-reflow in degenerated saphenous vein graft interventions: comparison of intracoronary verapamil and nitroglycerin.
No-flow has been reported after 10-15% of percutaneous interventions on degenerated saphenous vein grafts. In this prospective study of 36 degenerated saphenous vein graft lesions (32 patients), no-flow (TIMI flow < 3 in the absence of a significant lesion or dissection) occurred in 15/36 (42%) lesions. A total of 32 episodes of no-flow occurred after angioscopy (n = 14), extraction atherectomy (n = 10), balloon angioplasty (n = 2) or stent implantation (n = 6). Intragraft nitroglycerin (100-300 micrograms) alone resulted in no improvement in TIMI flow in the setting of no-reflow (TIMI flow 1.2 +/- 0.6 to 1.4 +/- 0.8, P = NS). Intragraft verapamil (100-500 micrograms) resulted in improvement in flow in all 32 episodes (TIMI flow 1.4 +/- 0.8 before, to 2.8 +/- 0.5 after verapamil, P < 0.001). Although verapamil increased TIMI flow after all episodes of no-reflow, two (6.3%) had persistent no-reflow (TIMI 1) despite verapamil, associated with non-Q wave myocardial infarction. In conclusion, treatment of no-reflow with verapamil during degenerated vein graft interventions was associated with reestablishment of TIMI 3 flow in 88% of cases. In contrast, intragraft nitroglycerin alone was ineffective for reversing no-reflow.
Kaplan
B M
BM
Division of Cardiology (Department of Internal Medicine), William Beaumont Hospital, Royal Oak, Michigan 48073, USA.
Benzuly
K H
KH
Kinn
J W
JW
Bowers
T R
TR
Tilli
F V
FV
Grines
C L
CL
O'Neill
W W
WW
Safian
R D
RD
D000368:Aged; D002121:Calcium Channel Blockers / Q000008:administration & dosage / Q000627:therapeutic use; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D005260:Female; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology; D006085:Graft Survival / Q000187:drug effects; D006801:Humans; D007269:Injections, Intra-Arterial; D008297:Male; D008875:Middle Aged; D005996:Nitroglycerin; D011379:Prognosis; D011446:Prospective Studies; D012039:Regional Blood Flow / Q000502:physiology; D012501:Saphenous Vein / Q000502:physiology*; D014665:Vasodilator Agents / Q000008:administration & dosage / Q000627:therapeutic use; D014700:Verapamil / Q000008:administration & dosage / Q000627:therapeutic use
D002121:Calcium Channel Blockers; D014665:Vasodilator Agents; D014700:Verapamil; D005996:Nitroglycerin