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Intracoronary pharmacotherapy in the management of coronary microvascular dysfunction

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Abstract

Although percutaneous coronary intervention restores optimal epicardial blood flow in most cases, abnormal myocardial perfusion may still persist. This might be as a result of macro and microembolization, neutrophil plugging, vasoconstriction, myocyte contracture, local intracellular and interstitial edema, intramural haemorrhage, and endothelial blistering. Local delivery of intracoronary pharmacotherapy via the coronary arteries may increase local drug concentration several fold, and may improve drug efficacy. Several pharmacological agents such as adenosine, calcium channel blockers, α blockers, β2 receptor activators, vasodilators, antithrombotics, and antiplatelet agents have been used to treat coronary microvascular dysfunction. This article reviews the results of trials of intracoronary pharmacotherapy to date.

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Abbreviations

ACEI:

Angiotensin converting enzyme inhibitor

ACS:

Acute coronary syndrome

AMI:

Acute myocardial infarction

AMISTAD:

Acute Myocardial Infarction Study of Adenosine

BP:

Blood pressure

CBF:

Coronary blood flow

CBFV:

Coronary blood flow velocity

CCB:

Calcium channel blocker

CFR:

Coronary flow reserve

CTFC:

Corrected TIMI frame count

CX:

Circumflex artery

FFR:

Fractional flow reserve

GPIIbIIIa:

Glycoprotein IIbIIIa inhibitor

IC:

Intracoronary

IV:

Intravenous

LAD:

Left anterior descending artery

LV:

Left ventricle

MI:

Myocardial infarction

NO:

Nitric oxide

NTG:

Nitroglycerin

NTP:

Nitroprusside

PCI:

Percutaneous coronary intervention

PTCA:

Percutaneous transluminal coronary angioplasty

RCA:

Right coronary artery

SK:

Streptokinase

STEMI:

ST elevation myocardial infarction

SVG:

Saphenous vein graft

TFG:

TIMI flow grade

TIMI:

Thrombolysis In Myocardial Infarction

TMPG:

TIMI myocardial perfusion grade

TNK:

Tenecteplase

VAPOR:

VAsodilator Prevention On no-Reflow

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Authors and Affiliations

  1. PERFUSE Study Group, Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 350 Longwood Avenue, First Floor, Boston, MA, 02115, USA

    Vijayalakshmi Kunadian, Cafer Zorkun, Scott P. Williams, Leah H. Biller, Alexandra M. Palmer, Katherine J. Ogando, Michelle E. Lew, Navin Nethala, William J. Gibson, Susan J. Marble, Jacqueline L. Buros & C. Michael Gibson

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  1. Vijayalakshmi Kunadian
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Correspondence to C. Michael Gibson.

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The authors have received research grant support from Genetech. Dr. Vijayalakshmi Kunadian has received unrestricted educational research grant support from South Cleveland Heart Fund, The James Cook University Hospital, Middlesbrough, United Kingdom.

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Kunadian, V., Zorkun, C., Williams, S.P. et al. Intracoronary pharmacotherapy in the management of coronary microvascular dysfunction. J Thromb Thrombolysis 26, 234–242 (2008). https://doi.org/10.1007/s11239-008-0276-0

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