Volume 45, Issue 4 pp. 360-365
Original Study

Reversal of “no reflow” during vein graft stenting using high velocity boluses of intracoronary adenosine

Tim A. Fischell MD

Corresponding Author

Tim A. Fischell MD

Michigan State University, Heart Institute at Borgess Medical Center, Kalamazoo, MI

Professor of Medicine, Michigan State University, Hearth Institute at Borgess Medical center, 1521 Gull Road, Kalamazoo, MI 49001Search for more papers by this author
Andrew J. Carter DO

Andrew J. Carter DO

Michigan State University, Heart Institute at Borgess Medical Center, Kalamazoo, MI

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Malcolm T. Foster MD

Malcolm T. Foster MD

Michigan State University, Heart Institute at Borgess Medical Center, Kalamazoo, MI

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Kelley Hempsall RN

Kelley Hempsall RN

Michigan State University, Heart Institute at Borgess Medical Center, Kalamazoo, MI

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Jennifer DeVries

Jennifer DeVries

Michigan State University, Heart Institute at Borgess Medical Center, Kalamazoo, MI

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Dennis H. Kim

Dennis H. Kim

Michigan State University, Heart Institute at Borgess Medical Center, Kalamazoo, MI

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Ann Kloostra RN

Ann Kloostra RN

Michigan State University, Heart Institute at Borgess Medical Center, Kalamazoo, MI

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Abstract

Slow or no reflow is a serious problem complicating catheter-based revascularization of degenerated saphenous vein bypass grafts. We examined the efficacy of rapidly delivered, high-velocity injections of intracoronary adenosine to reverse 11 slow-flow events complicating stenting of diseased bypass grafts. Ten of 11 events were rapidly improved to TIMI 3 flow by this technique within 3.8 ± 1.6 min of the initial adenosine injection. In an ex vivo model, 3-ml syringes created higher peak pressures and velocities than 10- and 20-ml syringes. We conclude that rapid and repeated high-velocity intragraft administration of adenosine is a promising new approach to promptly reverse no-reflow events complicating PTCA and stenting of diseased saphenous vein grafts. Ex vivo studies demonstrate a potentially important mechanical advantage with the use of small syringes for injection. Further randomized studies will be required to better define the mechanism(s) and efficacy of this approach for treating no reflow, including its use in native vessels. Cathet. Cardiovasc. Diagn. 45:360–365, 1998. © 1998 Wiley-Liss, Inc.

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