Microcirculation impairment in endovascular procedures in acute coronary syndrome: assessment and prevention

Б.А. Минько¹, Д.В. Тепляков²

Authors: B.A. Minko(1), D.V. Teplyakov(2)

Place: St Petersburg, Russia

Institution: 1 Russian Scientific Center of Radiology and Surgery Technologies 2 Pokrovskaya Municipal Hospital

Abstract: Background. The article reviews the main clinical trials on the management of acute coronary syndrome (ACS) and approaches to the intracoronary thrombi. The results of the Russian study are also presented. Percutaneous coronary intervention (PCI) is the most effective revascularization method, nowadays has become the preferable therapeutic method in ACS. However, reestablishing blood flow in epicardial artery with balloon angioplasty and stenting can be complicated by microvascular damage, primarily due to distal embolization. Preventive procedures could help to preserve the microvascular circulation and improve the results of the intervention. Objective. To assess the impact of bolus infusion of IIb/IIIa receptor inhibitor (Eptifibatide) on the microcirculation in PCI. Methods. Seventy one patients with ACS underwent primary PCI and traditional intravenous or intracoronary bolus of of IIb/IIIa receptor inhibitor was performed. The TIMI grade flow, corrected TIMI frame count, myocardial blush and ST segment resolution were measured after coronary flow restoration, after Eptifibatide bolus administration and after coronary stenting. Conclusions. Selective, intracoronary bolus administration of IIb/IIIa receptor inhibitor is a safe and highly effective method contributing to better thrombus desagregation and preventing distal embolization and microcirculation impairment in ACS patients undergoing PCI.  

Keywords: acute coronary syndrome, percutaneous coronary intervention, no-reflow / slow-flow syndrome, thrombus aspiration, IIb/IIIa receptor inhibitor intracoronary infusion

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