Adenosine use during aortocoronary vein graft interventions reverses but does not prevent the slow-no reflow phenomenon

S. Sdringola, A. Assali, M. Ghani, A. Yepes, O. Rosales, G. W. Schroth, Kenichi Fujise, H. V. Anderson, R. W. Smalling

Research output: Contribution to journalArticle

63 Citations (Scopus)

Abstract

Slow or no reflow (SNR) complicates 10-15% of cases of percutaneous intervention (PI) in saphenous vein bypass graft (SVG). To date there have been limited options for the prevention and treatment of this common and potentially serious complication. We evaluated the procedural outcome of 143 consecutive SVG interventions. We compared patients who received pre-intervention intra-graft adenosine boluses with those who did not. In addition we examined the efficacy of adenosine boluses to reverse slow-no reflow events. Angiograms were reviewed and flow graded (TIMI grade) by film readers blinded to the use of any intraprocedural drug or clinical history. Seventy patients received intragraft adenosine boluses before percutaneous intervention (APPI), 73 received no preintervention adenosine (NoAPPI). There were no significant angiographic differences between the two groups at baseline. A total of 20 patients experienced SNR. The incidence of SNR was similar in the two groups (APPI = 14.2% vs. NoAPPI = 13.6%, P = 0.9). SNR was treated with repeated, rapid boluses (24 μg each) of intra-graft adenosine. Reversal of SNR was observed in 10 of 11 patients (91%) who received high doses of adenosine (≥5 boluses, mean 7.7 ± 2.6) and in 3 of 9 (33%) of those who received low doses (<5 boluses, mean 1.5 ± 1.2). Final TIMI flow was significantly better in the high dose than in the low dose group (final TIMI 2.7 ± 0.6 vs. 2 ± 0.8, P = 0.04). No significant untoward complications were observed during adenosine infusion. These findings suggest that SNR after PI in SVG is not prevented by pre-intervention adenosine, but it can be safely and effectively reversed by delivery of multiple, rapid and repeated boluses of 24 μg of intra-graft adenosine. (C) 2000 Wiley-Liss, Inc.

Original languageEnglish (US)
Pages (from-to)394-399
Number of pages6
JournalCatheterization and Cardiovascular Interventions
Volume51
Issue number4
DOIs
StatePublished - 2000
Externally publishedYes

Fingerprint

No-Reflow Phenomenon
Adenosine
Veins
Transplants
Saphenous Vein
Angiography

Keywords

  • Adenosine
  • No-reflow
  • Saphenous vein graft

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging

Cite this

Adenosine use during aortocoronary vein graft interventions reverses but does not prevent the slow-no reflow phenomenon. / Sdringola, S.; Assali, A.; Ghani, M.; Yepes, A.; Rosales, O.; Schroth, G. W.; Fujise, Kenichi; Anderson, H. V.; Smalling, R. W.

In: Catheterization and Cardiovascular Interventions, Vol. 51, No. 4, 2000, p. 394-399.

Research output: Contribution to journalArticle

Sdringola, S. ; Assali, A. ; Ghani, M. ; Yepes, A. ; Rosales, O. ; Schroth, G. W. ; Fujise, Kenichi ; Anderson, H. V. ; Smalling, R. W. / Adenosine use during aortocoronary vein graft interventions reverses but does not prevent the slow-no reflow phenomenon. In: Catheterization and Cardiovascular Interventions. 2000 ; Vol. 51, No. 4. pp. 394-399.
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AU - Sdringola, S.

AU - Assali, A.

AU - Ghani, M.

AU - Yepes, A.

AU - Rosales, O.

AU - Schroth, G. W.

AU - Fujise, Kenichi

AU - Anderson, H. V.

AU - Smalling, R. W.

PY - 2000

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N2 - Slow or no reflow (SNR) complicates 10-15% of cases of percutaneous intervention (PI) in saphenous vein bypass graft (SVG). To date there have been limited options for the prevention and treatment of this common and potentially serious complication. We evaluated the procedural outcome of 143 consecutive SVG interventions. We compared patients who received pre-intervention intra-graft adenosine boluses with those who did not. In addition we examined the efficacy of adenosine boluses to reverse slow-no reflow events. Angiograms were reviewed and flow graded (TIMI grade) by film readers blinded to the use of any intraprocedural drug or clinical history. Seventy patients received intragraft adenosine boluses before percutaneous intervention (APPI), 73 received no preintervention adenosine (NoAPPI). There were no significant angiographic differences between the two groups at baseline. A total of 20 patients experienced SNR. The incidence of SNR was similar in the two groups (APPI = 14.2% vs. NoAPPI = 13.6%, P = 0.9). SNR was treated with repeated, rapid boluses (24 μg each) of intra-graft adenosine. Reversal of SNR was observed in 10 of 11 patients (91%) who received high doses of adenosine (≥5 boluses, mean 7.7 ± 2.6) and in 3 of 9 (33%) of those who received low doses (<5 boluses, mean 1.5 ± 1.2). Final TIMI flow was significantly better in the high dose than in the low dose group (final TIMI 2.7 ± 0.6 vs. 2 ± 0.8, P = 0.04). No significant untoward complications were observed during adenosine infusion. These findings suggest that SNR after PI in SVG is not prevented by pre-intervention adenosine, but it can be safely and effectively reversed by delivery of multiple, rapid and repeated boluses of 24 μg of intra-graft adenosine. (C) 2000 Wiley-Liss, Inc.

AB - Slow or no reflow (SNR) complicates 10-15% of cases of percutaneous intervention (PI) in saphenous vein bypass graft (SVG). To date there have been limited options for the prevention and treatment of this common and potentially serious complication. We evaluated the procedural outcome of 143 consecutive SVG interventions. We compared patients who received pre-intervention intra-graft adenosine boluses with those who did not. In addition we examined the efficacy of adenosine boluses to reverse slow-no reflow events. Angiograms were reviewed and flow graded (TIMI grade) by film readers blinded to the use of any intraprocedural drug or clinical history. Seventy patients received intragraft adenosine boluses before percutaneous intervention (APPI), 73 received no preintervention adenosine (NoAPPI). There were no significant angiographic differences between the two groups at baseline. A total of 20 patients experienced SNR. The incidence of SNR was similar in the two groups (APPI = 14.2% vs. NoAPPI = 13.6%, P = 0.9). SNR was treated with repeated, rapid boluses (24 μg each) of intra-graft adenosine. Reversal of SNR was observed in 10 of 11 patients (91%) who received high doses of adenosine (≥5 boluses, mean 7.7 ± 2.6) and in 3 of 9 (33%) of those who received low doses (<5 boluses, mean 1.5 ± 1.2). Final TIMI flow was significantly better in the high dose than in the low dose group (final TIMI 2.7 ± 0.6 vs. 2 ± 0.8, P = 0.04). No significant untoward complications were observed during adenosine infusion. These findings suggest that SNR after PI in SVG is not prevented by pre-intervention adenosine, but it can be safely and effectively reversed by delivery of multiple, rapid and repeated boluses of 24 μg of intra-graft adenosine. (C) 2000 Wiley-Liss, Inc.

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