Myocardial Staining (TMPG 1)  Post-Stent in AMI 28.6% % TMPG 1 13.5% n = 118 n = 118 CM Gibson, J Thrombolysis & Thrombosis, 2002 in press

Intracoronary Devices and Embolic Potential Lecture Notes The left panel shows the results of nuclear scanning performed during rotablation. This demonstrates that rotablation is associated with the development of new perfusion defects during the procedure, most likely due to distal embolization. Abciximab therapy reduced the incidence of perfusion defects as shown in the upper panel. Two new embolization protection devices are shown in the right panel that may reduce the incidence of distal embolization during PCI. (Topol, 1999; Topol, 2000) Topol, E. Circulation. 2000;101:570-580.

Intracoronary Serotonin Release After Stenting Stenting causes greater serotonin release than PTCA Stenting may cause greater arterial damage, greater plt. deposition, and greater plt. activation leading to vasoconstriction Leosco et al, AJC 1999;84:1317-1322

Impact of IC Adenosine & GP 2b3a Inhibitor on TIMI Myocardial Perfusion Grade Post PTCA Post PTCA + Adenosine Distal LAD with TIMI 3 Grade Blush Distal LAD with no blush (DSA = 0.1 Gray) (DSA = 5.2 Gray) CM Gibson 2000

% Death, MI, CHF, Recurrent Angina Impact of IC Adenosine on Clinical & Electrocardiographic Outcomes in the Setting Primary PTCA N=27 Placebo N=27 Adenosine 4 mg in 2 ml via central lumen of PTCA balloon p < 0.02 p < 0.03 p < 0.04 % of Patients % Death, MI, CHF, Recurrent Angina % Developing Q Waves Marzilli et al, Circulation 2000; 101:2154-2159

Hypothermia in MI Reduces Infarct Size No Cooling Cooling

Non-culprit CTFCs Improve Following PCI of the Culprit Artery 10.4 + 16.0 Dilating the culprit stenosis speeds up flow in the uninvolved artery (non-culprit artery) in acute coronary syndromes P < 0.0001 CTFC Improvement in Non-Culprit N = 134 N = 228 - 0.7 + 8.6 Gibson CM et al, Am J Cardiol 2000

Alpha Adrenergic Blockade Improves Recovery of Myocardial Perfusion After Stenting in AMI Gregorini et al, Circulation 1999; 99: 482-490

Alpha Adrenergic Blockade Improves Recovery of Myocardial Perfusion After Stenting in AMI Gregorini et al, Circulation 1999; 99: 482-490

Downstream Targets Large embolii: Filters Small embolii (thrombii): Filters & GP 2b3a inhibitors Vasoconstrictor release: GP 2b3a inhibitors Spasm: Adenosine, Ca channel blockers, alpha blockers, avoid over sizing with PCI, high pressure inflations, serotonin inhibitors, endothelin inhibitors Endothelial & Myocardial swelling: Ca channel blockers, hypothermia, DHEA, Na / H pump inhibitors, anti-inflammatory approaches