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The Relationship of Intracoronary Stent Placement Following Thrombolytic Therapy to Tissue Level Perfusion

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Abstract

Background: Stenting has been shown to improve lumen diameters and thereby improve epicardial blood flow, but the impact of stent placement on tissue level perfusion has not been well characterized. Methods: Data were drawn from the LIMIT trial of rhuMAb CD18 (anti WBC antibody) in acute myocardial infarction (AMI). Adjunctive/rescue stenting was performed at the discretion of the investigator. The TIMI Myocardial Perfusion Grade (TMPG) was assessed and digital subtraction angiography (DSA) was used to quantify brightness of the myocardial blush. Results: TIMI 3 flow was 54.2% (64/118) before stent placement, and improved to 87.2% (102/117, p < 0.001) following stent placement. Likewise, Corrected TIMI Frame Counts (CTFCs) improved from medians of 37.6 to 21 (p < 0.001). By DSA, the rate of growth in brightness also tended to be greater after stenting (2.3 ± 0.4 Gray/sec, n = 54 vs 3.1 ± 0.3, n = 54, p = 0.07). The incidence of TMPG 0 decreased following stent placement (25.2% (29/118) vs 14.3% (16/118), p = 0.03) and the incidence of a stain in the myocardium (TMPG 1) increased (13.5% (16/118) vs 28.6% (34/118), p = 0.004). Conclusion: Adjunctive stenting following thrombolytic administration in AMI improves epicardial TIMI 3 flow and TIMI frame counts as well as dye inflow into the myocardium: TMPG 0 is reduced and myocardial blush measured quantitatively by DSA tends to be brighter. However, more TMPG 1 or dye staining was present on next injection, suggesting dye outflow may be impaired.

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Authors and Affiliations

  1. Harvard Clinical Research Institute, USA

    C. Michael Gibson & Sabina A. Murphy

  2. Beth Israel Deaconess Medical Center, USA

    Daniel Frisch

  3. Genentech Inc, USA

    Steven G. Gourlay & Hal V. Barron

  4. The Cardiovascular Division Mayo Clinic, USA

    Raymond Gibbons

  5. St. Paul Heart Clinic, USA

    Kenneth W. Baran

  6. Université de Sherbrooke, USA

    Michel Nguyen

  7. University of Medicine and Dentistry of New Jersey, USA

    Sebastian Palmeri

  8. Cardiovascular Division, Department of Medicine, The University of California, San Francisco

    Hal V. Barron

Authors
  1. C. Michael Gibson
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  2. Daniel Frisch
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  3. Sabina A. Murphy
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  4. Steven G. Gourlay
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  5. Raymond Gibbons
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  6. Kenneth W. Baran
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  7. Michel Nguyen
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  8. Sebastian Palmeri
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  9. Hal V. Barron
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Gibson, C.M., Frisch, D., Murphy, S.A. et al. The Relationship of Intracoronary Stent Placement Following Thrombolytic Therapy to Tissue Level Perfusion. J Thromb Thrombolysis 13, 63–68 (2002). https://doi.org/10.1023/A:1016253028348

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  • DOI: https://doi.org/10.1023/A:1016253028348

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