title: Local heparin delivery for prevention of second in-stent restenosis. Acute and long-term results in 47 consecutive cases.
abstract: BACKGROUND: Heparin has been shown to reduce intimal thickening after arterial wall injury by inhibiting vascular smooth muscle cell proliferation and migration. The authors studied the acute and long-term results after local delivery of heparin after balloon angioplasty for in-stent restenosis. METHODS AND RESULTS: Forty-seven in-stent restenosis cases, 32 of them longer than 1 cm, were enrolled. After angioplasty local heparin delivery was performed using the Dispatch coronary infusion catheter (Scimed Life Systems/Boston Scientific Corp, Natick, MA, USA); the infusion rate was 99.9 ml per hour and a target dosage of 4000 iu heparin per site was intended to be delivered. In nine cases (19.15%) heparin delivery had to be stopped because of ischemia. One patient died six days after intervention. After a follow-up interval of 6-12 months target vessel revascularization rate was 28.26%. CONCLUSIONS: For the protocol used ischemia occurred more often than previously reported. Considering the fact that most patients had diffuse in-stent restenosis, the target revascularization rate at follow-up was acceptable.
authors.affiliation: Klinikum St Marien, Medizinische Klinik I, Amberg, Germany.
authors.forename: Harald
authors.initials: H
authors.lastname: Franck
authors.forename: Klaus
authors.initials: K
authors.lastname: Weber
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Pieper
authors.forename: Werner
authors.initials: W
authors.lastname: Frese