Safety and feasibility of selective intracoronary hypothermia in acute myocardial infarction
| Autor: | Brueren Grg, Van Hagen E, van 't Veer M, Helmes H, van Nunen Lx, Nils P. Johnson, Tonino Pal, Inge Wijnbergen, Frederik M. Zimmermann, Pijls Nhj, Luuk C. Otterspoor |
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| Přispěvatelé: | Cardiovascular Biomechanics |
| Rok vydání: | 2017 |
| Předmět: |
Male
medicine.medical_specialty medicine.medical_treatment Myocardial Infarction Hemodynamics Infarction Myocardial Reperfusion Pilot Projects Sodium Chloride/administration & dosage Hypothermia 030204 cardiovascular system & hematology Sodium Chloride Clinical research Myocardial Infarction/therapy 03 medical and health sciences 0302 clinical medicine Myocardial Reperfusion/methods Hypothermia Induced Internal medicine Occlusion medicine Humans 030212 general & internal medicine Myocardial infarction Innovation Aged Other technique business.industry Percutaneous coronary intervention Middle Aged medicine.disease ST-elevation myocardial infarction (STEMI) Induced/adverse effects medicine.anatomical_structure Hypothermia Induced/adverse effects Cardiology Feasibility Studies Female medicine.symptom Cardiology and Cardiovascular Medicine business Reperfusion injury Artery |
| Zdroj: | EuroIntervention, 13(12), e1475-e1482. EuroPCR |
| ISSN: | 1969-6213 1774-024X |
| Popis: | Aims: Hypothermia reduces reperfusion injury and infarct size in animal models of acute myocardial infarction if started before reperfusion. Human studies have not confirmed benefit, probably due to insufficient myocardial cooling and adverse systemic effects. This study sought to assess the safety and feasibility of a novel method for selective, sensor-monitored intracoronary hypothermia. Methods and results: Ten patients undergoing primary percutaneous coronary intervention (PPCI) were included. Saline at room temperature was administered distal to the culprit lesion through an inflated overthe- wire balloon (OTWB) in order to cool the endangered myocardium for 10 minutes (occlusion phase). Next, the OTWB was deflated and cooling continued with saline at 4°C for another 10 minutes (reperfusion phase). A sensor-tipped temperature wire in the distal coronary artery allowed titration of the infusion rate to achieve the desired coronary temperature (6°C below body temperature). Target coronary temperature was achieved within 27 seconds (median; IQR 21-46). Except for two patients with inferior wall infarction experiencing transient conduction disturbances, no side effects occurred. Systemic temperature remained unchanged. Finally, PPCI was performed as per routine. Conclusions: Selective hypothermia of the infarct area by intracoronary infusion of saline provides a novel method to reduce coronary temperature quickly and guarantee local myocardial hypothermia. In anterior wall myocardial infarctions, the protocol appeared safe, without serious haemodynamic or systemic side effects. In inferior wall myocardial infarctions, transient conduction abnormalities of short duration occurred. Potentially, selective intracoronary delivery of hypothermia could attenuate reperfusion injury caused by traditional PPCI. |
| Databáze: | OpenAIRE |
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