Intracoronary pharmacotherapy in the management of coronary microvascular dysfunction.
Although percutaneous coronary intervention restores optimal epicardial blood flow in most cases, abnormal myocardial perfusion may still persist. This might be as a result of macro and microembolization, neutrophil plugging, vasoconstriction, myocyte contracture, local intracellular and interstitial edema, intramural haemorrhage, and endothelial blistering. Local delivery of intracoronary pharmacotherapy via the coronary arteries may increase local drug concentration several fold, and may improve drug efficacy. Several pharmacological agents such as adenosine, calcium channel blockers, alpha blockers, beta2 receptor activators, vasodilators, antithrombotics, and antiplatelet agents have been used to treat coronary microvascular dysfunction. This article reviews the results of trials of intracoronary pharmacotherapy to date.
Kunadian
Vijayalakshmi
V
PERFUSE Study Group, Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 350 Longwood Avenue, First Floor, Boston, MA 02115, USA.
Zorkun
Cafer
C
Williams
Scott P
SP
Biller
Leah H
LH
Palmer
Alexandra M
AM
Ogando
Katherine J
KJ
Lew
Michelle E
ME
Nethala
Navin
N
Gibson
William J
WJ
Marble
Susan J
SJ
Buros
Jacqueline L
JL
Gibson
C Michael
CM
D054058:Acute Coronary Syndrome / Q000188:drug therapy*; D002986:Clinical Trials as Topic; D003326:Coronary Circulation; D006801:Humans; D007261:Infusions, Intra-Arterial; D055806:Microvessels / Q000503:physiopathology; D015425:Myocardial Reperfusion; D054318:No-Reflow Phenomenon / Q000188:drug therapy*