Comparison of intracoronary adenosine and isosorbide dinitrate on no-reflow/slow flow during rotational atherectomy.
OBJECTIVE
To compare the effect of intracoronary adenosine and isosorbide dinitrate (ISDN) on no-reflow/slow flow during high-speed rotational atherectomy (HSRA) in patients with complex coronary artery disease (CAD).


RESULTS
Medical records from consecutive patients diagnosed with complex CAD between November 2002 and March 2006 who underwent HSRA at the Tri-Service General Hospital, National Defence Medical Centre in Taipei, Taiwan, were included in this study. Patients in the adenosine group (n=32) received a 50 microg intracoronary adenosine bolus prior to the initiation of burr rotation and during each ablation. Patients in the ISDN group (n=58) received a 0.5 mg intracoronary ISDN bolus at comparable time points. Angiographic success was achieved in 100% of patients in the adenosine group and 98.3% (57/58) in the ISDN group.The procedural success rates were 96.9% (31/32) in the adenosine group and 89.7% (52/58) in the ISDN group. One patient (3.1%) from the adenosine group and six patients (10.3%) from the ISDN group experienced no-reflow/slow flow (P = 0.414). No in-hospital mortality occurred and target vessel revascularization was unnecessary.


CONCLUSIONS
Intracoronary administration of either adenosine or ISDN during HSRA appears safe and administration of either agent may be effective in decreasing the incidence of no-reflow/slow flow during HSRA. Further large, prospective, randomized, placebo-controlled trials are required.
Tsao
Tien-Ping
TP
Division of Cardiology, Department of Internal Medicine, Tri-Service General Hospital, National Defence Medical Centre, Taiwan, Republic of China.
Cheng
Shu-Meng
SM
Cheng
Cheng-Chung
CC
Yang
Shih-Ping
SP
D000241:Adenosine / Q000008:administration & dosage / Q000493:pharmacokinetics*; D000368:Aged; D017225:Atherectomy, Coronary / Q000379:methods*; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000378:metabolism / Q000628:therapy*; D003326:Coronary Circulation / Q000187:drug effects*; D003331:Coronary Vessels / Q000378:metabolism* / Q000503:physiopathology / Q000601:surgery; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007269:Injections, Intra-Arterial; D007548:Isosorbide Dinitrate / Q000008:administration & dosage / Q000493:pharmacokinetics*; D008297:Male; D016343:Monitoring, Intraoperative; D012039:Regional Blood Flow / Q000187:drug effects*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000008:administration & dosage / Q000493:pharmacokinetics
D014665:Vasodilator Agents; D007548:Isosorbide Dinitrate; D000241:Adenosine