Effects of Intraaortic Balloon Pumping on the Angiographic No-Reflow Phenomenon After Percutaneous Coronary Intervention in Patients With Anterior Myocardial Infarction

Abstract

ntraaortic balloon pumping (IABP) is widely used in patients with cardiogenic shock, as well as in many other situations such as support for high risk angioplasty, refractory congestive heart failure, and post-myocardial infarction unstable angina. 1 The effects of IABP are considered to be a reduction in myocardial oxygen demand because of systolic left ventricular (LV) unloading and an increase in coronary blood flow. Although the former effect is well recognized, the latter effect remains controversial, 2-6 because previous studies have reported that coronary blood flow during IABP either increased 2,6 or remained unchanged. 3,7 Percutaneous coronary intervention (PCI) is used as a treatment for acute myocardial infarction (AMI), and one of its major complications is the angiographic no-reflow phenomenon. Once this phenomenon occurs, the prognosis is extremely poor. [8][9][10][11] Although IABP is sometimes used in such patients to increase the diastolic coronary blood flow, there is little available information regarding the effects of IABP on the angiographic no-reflow phenomenon. TheCirculation Journal Vol. 70, January 2006 purpose of the current study was to examine whether IABP augments diastolic coronary flow in patients with the noreflow phenomenon after PCI for anterior AMI. We used transthoracic Doppler echocardiography (TTDE), which enables evaluation of the flow in the distal left anterior descending artery (LAD) 12,13 to assess the coronary flow velocity during IABP counterpulsation, and we compared the effects of IABP between angiographic no-reflow and good reflow patients. Methods Study PopulationThe study group comprised 17 consecutive patients with anterior AMI who underwent IABP for typical clinical indications. Patients with atrial fibrillation, severe valvular heart disease or previous coronary bypass graft surgery were excluded.All participants gave written informed consent for coronary angiography and IABP placement. The study was approved by the ethics committee of the hospital. IABP and Coronary AngiographyEach IABP was inserted via the femoral artery using a percutaneous insertion technique. Coronary angiography was performed in all patients via the femoral artery in a routine manner using the Judkins technique, either before Background The effects of intraaortic balloon pumping (IABP) are considered to be a reduction in myocardial oxygen demand because of systolic left ventricular unloading and an increase in coronary blood flow. Although the former effect has been consistently recognized, the latter effect remains controversial. The purpose of this study was to examine the effects of IABP on the angiographic no-reflow phenomenon. Methods and ResultsThe coronary flow velocity pattern of the left anterior descending artery (LAD) was assessed by transthoracic Doppler echocardiography during IABP counterpulsation, and the effects of IABP were compared between angiographic no-reflow and good reflow patients. The study group comprised 17 patients with anterior myocardial infarction who ...

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

“…5,24,25 The aforementioned pathophysiological mechanism is supported by the fact that in our study we observed a significant positive correlation both between afterload and infarcted area (Figure 5B) and between infarcted area and NR area (Figure 5C). Taking the above into consideration, it is conceivable that interventions that increase reperfusion pressure and myocardial blood flow but concurrently decrease left ventricular afterload and myocardial oxygen consumption (like the intra-aortic balloon pump) 26,27 may result in attenuation of the NR phenomenon. 28,29 Second, increased afterload may directly affect NR, irrespective of changes in infarct size; elevations in blood pressure may result in increased resistance of the microvascular bed, due to higher extravascular resistive forces resulting from elevated left ventricular pressures (which increase in parallel with the aortic pressure).…”

Coronary Microvascular Obstruction in Acute Myocardial Infarction

“…129,130 Inadequate therapies Intra-aortic balloon pumping (IABP) is able to reduce myocardial oxygen demand due to systolic left ventricular unloading and increases myocardial perfusion. 131,132 However, Maekawa et al failed to show an increase of mean diastolic flow velocity and peak diastolic flow velocity in left anterior descending by IABP in patients with angiographic CMVO. 131 Moreover, IABP failed to reduce IS in high-risk PCI.…”

“…131,132 However, Maekawa et al failed to show an increase of mean diastolic flow velocity and peak diastolic flow velocity in left anterior descending by IABP in patients with angiographic CMVO. 131 Moreover, IABP failed to reduce IS in high-risk PCI. 132…”

The Usefulness of Ryusei<sup>®</sup> Perfusion Balloon for Treating Acute Coronary Syndrome with Vulnerable Plaque

“…In addition, it has been reported that distal protection devices are considered to be effective in preventing distal embolization, particularly in animal experimental studies [16]. A common practice is to use intra-aortic balloon pump (IABP) in patients with the no reflow phenomenon with the expectation of an increase in diastolic coronary flow and improved cardiac function [17]. The phenomenon is closely related to the clinical outcome of patients, and is one of the leading causes of death after PCI [18].…”