Effect of Elevated Reperfusion Pressure on “No Reflow” Area and Infarct Size in a Porcine Model of Ischemia–Reperfusion

Pantsios, Chris; Kapelios, Chris J.; Vakrou, Styliani; Διάκος, Νικόλαος; Pozios, Iraklis; Kontogiannis, Chris; Nanas, John N.; Malliaras, Konstantinos

doi:10.1177/1074248415617850

Cited by 14 publications

(8 citation statements)

References 38 publications

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“…202 In contrast, partial clamping of the aorta to increase perfusion pressure augmented infarct size and no-reflow in pigs. 203 Hypothermia (32°C) in rats and rabbits undergoing 30-minute coronary occlusion and reperfusion reduced infarct size and no-reflow area when initiated shortly after the onset of myocardial ischemia. 204 Of note, whereas in rabbits undergoing 30-minute coronary occlusion with reperfusion, topical hypothermia (32°C) when initiated at 5 minutes before versus at 5 minutes after reperfusion tended to reduce infarct size only with hypothermia started before reperfusion, the area of no-reflow was reduced in both cases.…”

Section: Interventionsmentioning

confidence: 99%

The Coronary Circulation as a Target of Cardioprotection

Heusch

2016

Circulation Research

209

160

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Abstract:The atherosclerotic coronary vasculature is not only the culprit but also a victim of myocardial ischemia/ reperfusion injury. Manifestations of such injury are increased vascular permeability and edema, endothelial dysfunction and impaired vasomotion, microembolization of atherothrombotic debris, stasis with intravascular cell aggregates, and finally, in its most severe form, capillary destruction with hemorrhage. In animal experiments, local and remote ischemic pre-and postconditioning not only reduce infarct size but also these manifestations of coronary vascular injury, as do drugs which recruit signal transduction steps of conditioning. Clinically, no-reflow is frequently seen after interventional reperfusion, and it carries an adverse prognosis. The translation of cardioprotective interventions to clinical practice has been difficult to date. Only 4 drugs (brain natriuretic peptide, exenatide, metoprolol, and esmolol) stand unchallenged to date in reducing infarct size in patients with reperfused acute myocardial infarction; unfortunately, for these drugs, no information on their impact on the ischemic/reperfused coronary circulation is available. (Circ Res.

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Section: Interventionsmentioning

confidence: 99%

The Coronary Circulation as a Target of Cardioprotection

Heusch

2016

Circulation Research

209

160

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“…This may be due to the failure of the thrombolytic or no-reflow effect. According to previous research [ 44 , 45 ], multiple factors, including microvascular obstruction, edema, and occlusion via the endothelium, could cause the no-reflow effect, even though the primary occlusion was resolved. Owing to this phenomenon, the tissue was unable to receive the nutritional support needed to recover sustainably, which might lead to more severe brain damage and a higher mRS score.…”

Section: Discussionmentioning

confidence: 99%

Predicting a Favorable (mRS 0–2) or Unfavorable (mRS 3–6) Stroke Outcome by Arterial Spin Labeling and Amide Proton Transfer Imaging in Post-Thrombolysis Stroke Patients

Jiang

et al. 2023

JPM

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(1) Background: The objective of this study was to determine whether arterial spin labeling (ASL), amide proton transfer (APT), or their combination could distinguish between patients with a low and high modified Rankin Scale (mRS) and forecast the effectiveness of the therapy; (2) Methods: Fifty-eight patients with subacute phase ischemic stroke were included in this study. Based on cerebral blood flow (CBF) and asymmetry magnetic transfer ratio (MTRasym) images, histogram analysis was performed on the ischemic area to acquire imaging biomarkers, and the contralateral area was used as a control. Imaging biomarkers were compared between the low (mRS 0–2) and high (mRS 3–6) mRS score groups using the Mann–Whitney U test. Receiver operating characteristic (ROC) curve analysis was used to evaluate the performance of the potential biomarkers in differentiating between the two groups; (3) Results: The rAPT 50th had an area under the ROC curve (AUC) of 0.728, with a sensitivity of 91.67% and a specificity of 61.76% for differentiating between patients with low and high mRS scores. Moreover, the AUC, sensitivity, and specificity of the rASL max were 0.926, 100%, and 82.4%, respectively. Combining the parameters with logistic regression could further improve the performance in predicting prognosis, leading to an AUC of 0.968, a sensitivity of 100%, and a specificity of 91.2%; (4) Conclusions: The combination of APT and ASL may be a potential imaging biomarker to reflect the effectiveness of thrombolytic therapy for stroke patients, assisting in guiding treatment approaches and identifying high-risk patients such as those with severe disability, paralysis, and cognitive impairment.

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“…When aortic pressure was increased by ˜20% over baseline, both the infarct area and the area of no-reflow were increased relative to control experiments. 197 Takeo et al observed that an optimal reduced perfusion flow rate to maximize left ventricular function could be found, though the translational value of the precise flow rate is limited as the work was performed in isolated rat hearts. 195 Similarly working in an isolated rat heart model, Nemlin et al found an optimal pressure for LPR of 51 mmHg (whereas normal pressure was 73 mmHg).…”

Section: Controlled Reperfusionmentioning

confidence: 99%

Controlling Reperfusion Injury With Controlled Reperfusion: Historical Perspectives and New Paradigms

Fischesser

Benton

et al. 2021

J Cardiovasc Pharmacol Ther

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Cardiac reperfusion injury is a well-established outcome following treatment of acute myocardial infarction and other types of ischemic heart conditions. Numerous cardioprotection protocols and therapies have been pursued with success in pre-clinical models. Unfortunately, there has been lack of successful large-scale clinical translation, perhaps in part due to the multiple pathways that reperfusion can contribute to cell death. The search continues for new cardioprotection protocols based on what has been learned from past results. One class of cardioprotection protocols that remain under active investigation is that of controlled reperfusion. This class consists of those approaches that modify, in a controlled manner, the content of the reperfusate or the mechanical properties of the reperfusate (e.g., pressure and flow). This review article first provides a basic overview of the primary pathways to cell death that have the potential to be addressed by various forms of controlled reperfusion, including no-reflow phenomenon, ion imbalances (particularly calcium overload), and oxidative stress. Descriptions of various controlled reperfusion approaches are described, along with summaries of both mechanistic and outcome-oriented studies at the pre-clinical and clinical phases. This review will constrain itself to approaches that modify endogenously-occurring blood components. These approaches include ischemic postconditioning, gentle reperfusion, controlled hypoxic reperfusion, controlled hyperoxic reperfusion, controlled acidotic reperfusion, and controlled ionic reperfusion. This review concludes with a discussion of the limitations of past approaches and how they point to potential directions of investigation for the future.

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Effect of Elevated Reperfusion Pressure on “No Reflow” Area and Infarct Size in a Porcine Model of Ischemia–Reperfusion

Abstract: Modestly elevated blood pressure during reperfusion is associated with an increase in no reflow area and in infarct size in a clinically relevant porcine model of ischemia-reperfusion.

Cited by 14 publications

References 38 publications

The Coronary Circulation as a Target of Cardioprotection

The Coronary Circulation as a Target of Cardioprotection

Predicting a Favorable (mRS 0–2) or Unfavorable (mRS 3–6) Stroke Outcome by Arterial Spin Labeling and Amide Proton Transfer Imaging in Post-Thrombolysis Stroke Patients

Controlling Reperfusion Injury With Controlled Reperfusion: Historical Perspectives and New Paradigms

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