Novel uses and potential for calcium antagonists in revascularization.
Calcium antagonists affect the arterial wall and blood components in many ways: these include their classical vasomotor functions, as well as newly-documented effects on platelet aggregation, rheology, the platelet membrane receptor glycoprotein IIb/IIIa complex and on tissue factor, a glycoprotein that initiates the clotting cascade. Calcium antagonists slow atherogenesis in animals, perhaps through inhibiting calcium incorporation, lowering heart rate or reducing thrombus formation, although no benefits were shown in prospective clinical studies of stenosis progression. However, it has been possible to attenuate proliferation in in vitro and in vivo experimental models. These discoveries are leading to novel calcium antagonist applications in revascularization. They have the potential to act synergistically in thrombolysis, but so far there has been very little evaluation of this. During coronary intervention, the myocardial protective action of calcium antagonists could be of benefit against stunning and in the no-reflow phenomenon. Their action on vasomotor tone and thrombus formation might affect acute closure or restenosis, although clinical studies have not yet shown this, perhaps because systemic administration of calcium antagonists does not achieve a high enough local concentration. Local drug delivery into the arterial wall may have potential. Calcium antagonists could be of use in cardiac surgery by preventing spasm or providing myocardial protection.
Nikol
S
S
Ludwig-Maximilians University, Klinikum Grosshadern, Munich, Germany.
Huehns
T Y
TY
Höfling
B
B
D000818:Animals; D002121:Calcium Channel Blockers / Q000008:administration & dosage / Q000494:pharmacology* / Q000627:therapeutic use; D003331:Coronary Vessels / Q000187:drug effects* / Q000503:physiopathology; D006801:Humans; D017202:Myocardial Ischemia / Q000188:drug therapy* / Q000503:physiopathology; D009204:Myocardial Revascularization / Q000379:methods
D002121:Calcium Channel Blockers