title: Local heparin delivery prior to coronary stent implantation: acute and six-month clinical and angiographic results.
abstract: Stents increase smooth muscle cell proliferation, which may also lead to in-stent restenosis. A local delivery strategy provides higher drug concentration at the angioplasty site and may limit the proliferative response following stenting. Local heparin delivery was attempted in 35 patients following balloon angioplasty using an "over-the-balloon" style catheter (infusion sleeve). The infusion sleeve was successfully tracked and heparin was delivered in 33 (94%) patients. Heparin (1,000 IU/ml) was delivered under low (45 psi, 2 ml, n = 4), intermediate (75 psi, 4 ml, n = 11), and high (100 psi, 4 ml, n = 18) proximal infusion pressures. Stent placement was successful in all cases. Acute and in-hospital complications were a severe arterial spasm after heparin delivery, a non Q-wave myocardial infarction, and two vascular complications. Ten dissections were observed after PTCA and prior to heparin delivery. Of these dissections, 7 remained unchanged, 2 worsened, and 1 improved with local delivery. When heparin was delivered in the absence of dissection, no new dissections were observed. Of the 33 patients who received heparin, 30 (91%) had no symptoms and a negative exercise test at clinical follow-up. QCA analysis of 6-month follow-up angiograms, performed in 32 of 33 (97%) patients, demonstrated an acute gain of 1.98 +/- 0.67 mm, a late loss of 0.94 +/- 0.78 mm, a net gain of 1.04 +/- 0.78 mm, and a loss index of 0.48 +/- 0.32. Restenosis (> or = 50% stenosis) was observed in 4 of 32 (12%) patients. Local delivery of heparin via the infusion sleeve following PTCA and prior to stent deployment is feasible with an acceptable safety profile and a low clinical and angiographic restenosis rate at 6 months.
authors.affiliation: Institute of Cardiology, University of Milan, Monzino Foundation IRCCS, Italy.
authors.forename: A L
authors.initials: AL
authors.lastname: Bartorelli
authors.forename: N B
authors.initials: NB
authors.lastname: De Cesare
authors.forename: A V
authors.initials: AV
authors.lastname: Kaplan
authors.forename: F
authors.initials: F
authors.lastname: Fabbiocchi
authors.forename: P
authors.initials: P
authors.lastname: Montorsi
authors.forename: L
authors.initials: L
authors.lastname: Squadroni
authors.forename: S
authors.initials: S
authors.lastname: Galli
authors.forename: P
authors.initials: P
authors.lastname: Sganzerla
authors.forename: A
authors.initials: A
authors.lastname: Loaldi
mesh_terms: D015906:Angioplasty, Balloon, Coronary; D002406:Catheterization, Peripheral / Q000295:instrumentation*; D017023:Coronary Angiography; D003327:Coronary Disease / Q000628:therapy; D016503:Drug Delivery Systems; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006493:Heparin / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D011446:Prospective Studies; D015607:Stents; D016896:Treatment Outcome
chemical_list: D006493:Heparin