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Call for CASES
Percutenous Controlled Reperfusion
For STEMI
Piotr P. Buszman
Silesian Medical School, Katowice, Poland
Introduction
I.
Distal emblization and reperfusion injury are a major
limitations of primary percutaneous intervention in
patients with STEMI.
Reperfusion injury
Description of the problem
I.
Age 60/ male
II.
Symptoms: Acute Myocardial Infarction
(chest pain lasting 3 hours)
III.
Medical history: Coronary Hart Desease
for 4 years
IV.
Risk factors: ex–smoker, hypertension,
hypercholesterolemia
Total cholesterol
229
mg%
HDL
36 mg%
LDL
171 mg%
TG
109 mg%
V.
LAD: 45LAO/25 cran
Acute anterior myocardial infarct caused
by occlusion of the mid LAD.
Intended strategy
I.
Primary
PTCA with
a
controlled
reperfusion:
-local delivery of IIb/IIIa receptor inhibitor
intramurally at the site of occlusion and
into coronary lumen behind occluded
segment
-glucose infusion through central lumen
of balloon catheter to enhance energetic
status of ischaemic myocardium.
II.
Coronary
plaques.
stenting
to
seal
ruptured
Local drug delivery (LDD)
Transport microporous
catheter Remedy 3,0mm
•
Administration of GP IIb /IIIa
inhibitor – ReoPro: locally
directly to the mural thrombus
and throug central lumen
distaly from occlusion.
•
Glucose
infusion
before
opening the vessel through
the central lumen of the
Remedy catheter: 20cc of 10%
Glucose.
•
No arrhythmia during and
after
reperfusion,
no
hemodynamic disturbances,
Reperfusion after LDD
I.
II.
I.
II.
III.
IV.
After local drug delivery TIMI 3
flow, a long lesion presented in
med. LAD
Stent implantation 2,75x12mm to
medial LAD and 2,5x24mm to
distal LAD (Liberty stents.)
Timi 3 flow after stent
implantation.
No residual stenosis.
Patient had no angina after the
procedure.
ST segment normalization
Ejection Fraction
LV prior to PCI: EF=55%
LV immediately after PCI: EF=59%
Immediate LV function improvement instead of myocardial stunning.
3 months Follow - up
Angiography:
No restenesosis in LAD
Succesful PCI to dist. Cx
LV-EF=65%
Further improvement of LV function
Summary
I.
II.
III.
IV.
A 60 year old male with acute myocardial
infarction was addmitted to the hospital.
ECG showed acute infarction of the anterior
wall.
Emergency PCI was performed with use of
controlled
reperfusion:
intracoronary
glucose infusion and GP IIb /IIIa inhibitor
given intramurally and distaly. Immediate LV
function improvement and TIMI 3 was
obtained.
3 months follow-up showed good vessel
patency and improved LV ejection fraction.