An alternative agent for radial arterial graft spasm: Application of topical iloprost

Özdemır, Coşkun; Ikizler, Murat; Beşoğul, Yavuz; Karakaya, Atalay; Sırmagül, Başar

doi:10.1080/14017430601150601

Cited by 8 publications

(5 citation statements)

References 20 publications

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“…9,21 Other topical pharmacological agents, such as the synthetic prostacyclin iloprost and diltiazem, have also been explored. 25,27 However, the half-lives of these therapies are minutes to hours, and efficacy data on these techniques are limited. A uniform ex vivo treatment and postoperative protocol for EC-IC bypass graft spasm prevention does not currently exist.…”

Section: Discussionmentioning

confidence: 99%

Botulinum toxin to improve vessel graft patency in cerebral revascularization surgery: report of 3 cases

Strickland¹,

Rennert

Bakhsheshian³

et al. 2019

Journal of Neurosurgery

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Surgical revascularization continues to play an important role in the management of complex intracranial aneurysms and ischemic cerebrovascular disease. Graft spasm is a common complication of bypass procedures and can result in ischemia or graft thrombosis. The authors here report on the first clinical use of botulinum toxin to prevent graft spasm following extracranial-intracranial (EC-IC) bypass. This technique was used in 3 EC-IC bypass surgeries, 2 for symptomatic carotid artery occlusions and 1 for a ruptured basilar tip aneurysm. In all 3 cases, the harvested graft was treated ex vivo with botulinum toxin before the anastomosis was performed. Post-bypass vascular imaging demonstrated patency and the absence of spasm in all grafts. Histopathological analyses of treated vessels did not show any immediate endothelial or vessel wall damage. Postoperative angiograms were without graft spasm in all cases. Botulinum toxin may be a reasonable option for preventing graft spasm and maintaining patency in cerebral revascularization procedures.

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Section: Discussionmentioning

confidence: 99%

Botulinum toxin to improve vessel graft patency in cerebral revascularization surgery: report of 3 cases

Strickland¹,

Rennert

Bakhsheshian³

et al. 2019

Journal of Neurosurgery

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“…The ICER of iloprost has yet to be studied, and the cost benefit of iloprost in high‐risk populations who cannot be fluid resuscitated, such as those with acutely decompensated chronic heart failure and renal insufficiency who must undergo coronary angiography, must be determined. Other potential benefits of iloprost include peripheral arterial vasodilatation during catheterization, and possibly prevention of arterial spasm …”

Section: Discussionmentioning

confidence: 99%

A Review of the Use of Iloprost, A Synthetic Prostacyclin, in the Prevention of Radiocontrast Nephropathy in Patients Undergoing Coronary Angiography and Intervention

Kassis

Minsinger

McCullough³

et al. 2015

Clinical Cardiology

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Iloprost, a prostacyclin analogue, has been effective in preventing renal dysfunction among transplant patients. We hypothesized that iloprost is protective against renal dysfunction in different settings, in which similar underlying mechanisms of nephrotoxicity occur. We conducted a literature review, and discuss the application of iloprost in reducing acute renal insufficiency and the pathophysiological mechanisms of contrast-induced nephropathy (CIN). One proposed mechanism of CIN is prolonged renal arterial vasoconstriction, causing renal hypoperfusion, ischemia, and release of free radicals. Iloprost is an analogue of the vasodilatory prostaglandin PGI 2 . It has demonstrated cytoprotective properties in the renal transplant population by inhibiting lysosomal degradation and release of free radicals, allowing membrane stabilization. Two good-quality studies reported on iloprost and CIN. Five studies reported protective effects of iloprost in renal transplantation and 1 in coronary artery bypass grafting. Iloprost was found to be renoprotective in patients with baseline renal insufficiency who underwent coronary angiography for CIN (risk ratio [RR] = 0.32, 95% confidence interval [CI]: 0.16-0.67) and increases the weighted mean difference improvement in creatinine clearance (RR = 4.56, 95% CI: 1.82-7.30). CIN is associated with major adverse cardiac events. Preventing CIN is important for patient safety and reducing disease burden. Iloprost may reduce CIN by up to 68%. The same mechanisms of iloprost that inhibit graft dysfunction in the acute post-renal transplant and cardiopulmonary bypass setting may also contribute to preventing CIN. Large randomized controlled trials are necessary to determine the clinical efficacy of iloprost in the angiography setting. IntroductionContrast-induced nephropathy (CIN), defined as >0.5 mg/dL increase or relative increase >25% of baseline creatinine approximately 48 to 72 hours after the administration of contrast, is expected to increase in incidence proportionally with the expected increase in cardiac interventions necessary in an aging population. Risk factors include preexisting renal insufficiency, diabetic nephropathy, age

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“…Another study showed the effects of iloprost as topical vasodilatation for the radial artery in 28 patients. In this study, iloprost, papaverine, diltiazem, and placebo-controlled solutions and the contraction-relaxation response for the radial artery were evaluated and they concluded that the effects of vasodilatation on the radial artery of the topical iloprost were equivalent to that of dapper tissue and that iloprost could be routinely used as a topical vasodilator [33] .…”

Section: Iloprostmentioning

confidence: 99%

Comparison of iloprost and papaverine in topical vasodilation of internal mammary artery in coronary artery bypass grafting: A prospective randomized trial

Yalvaç¹

2020

Haydarpasa Numune Med J

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Introduction: Internal mammary artery (IMA) graft is a commonly used coronary artery bypass conduit due to its high longterm patency rates. IMA may have a perioperative arterial spasm problem. Papaverine, an opium alkaloid, is commonly used in vasospasm, especially for IMA. Iloprost, a synthetic prostacyclin analogue, could be an alternative to papaverine. In this study, we compared the effects of topical iloprost and papaverine concerning the prevention of IMA vasospasm. Methods: Between May-August 2009, 40 consecutive patients who underwent coronary artery bypass grafting using IMA graft were included in this prospective study. Patients were divided into two groups to be treated with topical vasodilators as iloprost and papaverine groups. The free blood flow of IMA was measured before and after the topical vasodilators were applied. These results were evaluated together with concurrently measured mean arterial pressures. Histopathologic examination was performed with the distal part of IMA and scored according to the desquamation rate. Results: Preoperative and haemodynamic parameters between the two groups were similar. With both vasodilator agents, the amount of IMA blood flow was increased in a similar ratio as well. Analysis of this increase was assessed by dividing the blood flow by the mean arterial blood pressure value. Iloprost group had similar vasodilation response when compared with the response of the papaverine group. There was more desquamation in the papaverine group at a significant level. There was no significant difference between the two groups in terms of postoperative mortality and complications. Discussion and Conclusion: We concluded that iloprost could be an alternative for papaverine with similar vasodilation response and lower level of endothelial damage.

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An alternative agent for radial arterial graft spasm: Application of topical iloprost

Abstract: Iloprost can be recommended as a strong alternative to the topical agents used for preventing arterial graft spasm.

Cited by 8 publications

References 20 publications

Botulinum toxin to improve vessel graft patency in cerebral revascularization surgery: report of 3 cases

Botulinum toxin to improve vessel graft patency in cerebral revascularization surgery: report of 3 cases

A Review of the Use of Iloprost, A Synthetic Prostacyclin, in the Prevention of Radiocontrast Nephropathy in Patients Undergoing Coronary Angiography and Intervention

Comparison of iloprost and papaverine in topical vasodilation of internal mammary artery in coronary artery bypass grafting: A prospective randomized trial

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