Self-made side hole balloon for treating no-reflow following percutaneous coronary intervention
10.3724/S.P.J.1008.2014.00317
- Author:
Hong-Wen TAN
1
Author Information
1. Department of Cardiovasology, Changhai Hospital, Second Military Medical University
- Publication Type:Journal Article
- Keywords:
No-reflow;
Percutaneous coronary intervention;
Treatment
- From:
Academic Journal of Second Military Medical University
2014;35(3):317-320
- CountryChina
- Language:Chinese
-
Abstract:
Objective To assess the safety and effectiveness of self-made side hole balloon for treating no-reflow following percutaneous coronary intervention(PCI). Methods Twenty-three patients diagnosed with no-reflow during PCI from Jan. 2012 to Jan. 2013 were enrolled. Residual stenosis, thrombosis, dissection, and spasm of coronary artery were excluded. The mean age of the 23 patients was (62. 0±13. 8) years old. Of the 23 patients 14 had ST segment elevation myocardial infarction (STEMI), and 9 underwent elective PC.I. There were 11 cases with no-reflow in the left anterior descending branch, 8 in the right coronary artery and 4 in the circumflex branch. The drugs (nitroglycerin and tirofiban) were selectively injected into the vessel using sel-made side hole balloons. The thrombolysis in myocardial infarction (TIMI) grade before and after procedure, ST segment resolution (STR),ST-T changes for 24 and 72 hours and complications (perforation, dissection,and thrombosis of coronary artery) were observed postoperatively. Patientswere followed up by ECG and echocardiogram at 1 month after PC.I. Incidence of major adverse cardiovascular events (MACEs) and cardiac function were observed 6 months after PC.I. Results After intracoronary administration of drug therapy, TIMI grade-1 flow was found in 3 patients, TIMI grade-2 flow in 5 patients and TIMI grade-3 flow in15 patients. In patients with STEMI, complete resolution ((≥3;70%) was found in 8 patients,partial resolution (30%-69%) in 4, and no resolution (<30%) in 2. One of the 2 patients with ventricular electrical storm was treated with temporary cardiac pacing and drug therapy and recovered within 1 week; the other one with pericardial tamponadewho was treated with emergency surgery repair died. In 9 patients undergoing selected PCI, transient ST segment changes were noted in 3 patients which recovered within 1 week after conservative treatment; with no perforation, dissection,or thrombosis of coronary artery. One month after discharge, echocardiogram of the 22 patients showed a mean left ventricular ejection fraction (LVEF) of (50. 6± 14. 3) % and a fractional shortening in the short axis view of 0. 36±0. 04, and ECG showed non-specific changes of ST-T in 6 patients. In 4 patients with STEMI, culprit artery showed TIMI grade-3 by angiography performed during PCI for non-culprit vessel 1 month after primary PC.I. At 6 months after primary PCI, there was no MACE; 18 patientswere in New York Heart Association Class I and 4 in Class E. Conclusion Self-made side hole balloon is a safe, economical, effective and convenient method for intracoronary administration of nitroglycerin and tirofiban in treating no-flow during PCI, but the result still needs further verification.
