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Silesian Medical School, Katowice, Poland

Percutenous Controlled Reperfusion For STEMI

Piotr P. Buszman

IntroductionI. Distal emblization and reperfusion injury are a major

limitations of primary percutaneous intervention in patients with STEMI.

Reperfusion injury

Description of the problem

LAD: 45LAO/25 cran

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. Acute anterior myocardial infarct caused by occlusion of the mid LAD.

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 stenting to seal ruptured plaques.

Intended strategy

Local drug delivery (LDD)

• 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,

Transport microporous catheter Remedy 3,0mm

Reperfusion after LDD

I. After local drug delivery TIMI 3 flow, a long lesion presented in med. LAD

II. Stent implantation 2,75x12mm to medial LAD and 2,5x24mm to distal LAD (Liberty stents.)

I. Timi 3 flow after stent implantation.

II. No residual stenosis.

III. Patient had no angina after the procedure.

IV. ST segment normalization

LV immediately after PCI: EF=59%

Ejection Fraction

LV prior to PCI: EF=55%

Immediate LV function improvement instead of myocardial stunning.

3 months Follow - up

Angiography:No restenesosis in LADSuccesful PCI to dist. Cx

LV-EF=65%Further improvement of LV function

I. A 60 year old male with acute myocardial infarction was addmitted to the hospital.

II. ECG showed acute infarction of the anterior wall.

III. 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.

IV. 3 months follow-up showed good vessel patency and improved LV ejection fraction.

Summary