1. 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

2. 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:

3. 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:

4. 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

5. % 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:

6. Hypothermia in MI Reduces Infarct Size
No Cooling
Cooling

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

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

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

10. 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