Evaluation of Regional Myocardial Nutrient Perfusion Following Selective Retrograde Arterialization of the Coronary Vein

Rhodes, Glen R.; Syracuse, Donald C.; McIntosh, Charles L.

doi:10.1016/s0003-4975(10)63550-3

Cited by 12 publications

(7 citation statements)

References 15 publications

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“…Thus, animal studies, mostly involving sheep and dogs showed that arterialization of cardiac veins decreases infarct size only to a small degree 4 . These results find support in the observation that the retrograde flow established via the coronary sinus supplies only 14% to 15% of the normal myocardial oxygen requirement 10,11 . Park et al 5 performed arterialization of cardiac veins in six patients and argued that the observed failure of retrovenous perfusion was due to the associated direct aorto‐coronary artery bypass graft that resulted in increased pressure in the capillary bed.…”

Section: Resultsmentioning

confidence: 87%

Lack of Durability of Surgical Arterialization of Coronary Veins for the Treatment of Ischemic Heart Disease

Chowdhry¹,

Davies²,

McCance³

et al. 2005

Journal of Cardiac Surgery

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Section: Resultsmentioning

confidence: 87%

Lack of Durability of Surgical Arterialization of Coronary Veins for the Treatment of Ischemic Heart Disease

Chowdhry¹,

Davies²,

McCance³

et al. 2005

Journal of Cardiac Surgery

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“…This approach is particularly intriguing when disease is diffuse in the coronary artery and thus suboptimal for receiving a bypass graft. The feasibility of using coronary veins for myocardial revascularization was first reported in animal experiments and eventually in humans in the 1970s and has been reviewed [5, 7–14]. Limitations of the procedure included residual shunt flow and fibrous proliferation at the anastamosis and elsewhere in the native vein.…”

Section: Discussionmentioning

confidence: 99%

Correction of a saphenous vein graft to coronary vein anastamosis by selective retrograde coil‐induced occlusion to arterialize the native vein

Gurbel

Austin

Cho

et al. 2002

Cathet Cardio Intervent

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Section: Discussionmentioning

confidence: 99%

“…18 -21 They demonstrated the basic safety and feasibility of the technique after other authors had established the physiological mechanism of retroperfusion in animals. [22][23][24] Although these anecdotal reports offered promising results, with many patients experiencing partial or complete relief of anginal symptoms, the surgical approach was inexplicably abandoned.We recognized the potential for percutaneous venous arterialization using catheter-based technology and developed the concept in a series of animal studies. 25 The initial human feasibility trial focuses on no-option patients, because they represent the most appealing patient group from an ethical standpoint.…”

mentioning

confidence: 99%

Percutaneous In Situ Coronary Venous Arterialization

et al. 2001

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Abstract-Diffuse coronary artery disease is frequently untreatable by coronary artery bypass or angioplasty. Many such "no-option" patients have been subjects for trials of angiogenesis using growth factor manipulation or laser injury. We think these novel revascularization strategies are limited by insufficient inflow to putative areas of new microvasculature and thus seek a more mechanical solution. We report the use of a catheter-based system for arterializing the adjacent anterior cardiac vein in a patient with chronic total occlusion of the left anterior descending coronary artery. A composite catheter system (phased-array ultrasound imaging system mounted on a catheter with extendable nitinol needle) was used to deliver an exchange-length intracoronary guidewire from the proximal left anterior descending coronary artery into the parallel anterior interventricular vein. Using standard angioplasty techniques, a fistula was then constructed from the proximal artery to the coronary vein using a self-expanding connector. The proximal vein was blocked with a novel self-expanding "blocker," thus precluding "steal" through the coronary sinus and forcing retroperfusion of the anterior wall. The procedure was completed without complication, and a follow-up angiogram at 3 months confirmed continued patency of the arteriovenous connection. This patient, who had severe angina before the procedure, has been asymptomatic for 12 months. Percutaneous in situ venous arterialization may be an effective therapy for diffuse, "untreatable" coronary disease by supplying a robust inflow of arterialized blood via retroperfusion to severely ischemic myocardium. W ith the combination of coronary artery bypass surgery and percutaneous coronary interventions, many patients with symptomatic coronary insufficiency can be effectively revascularized. Each year in the United States alone, nearly 1 million individuals undergo a percutaneous catheterbased intervention, with intracoronary stents used in most. An additional half million Americans have their coronary disease treated by aortocoronary surgical bypass.Despite the successful and widespread application of these revascularization procedures, a large number of patients are not good candidates for either angioplasty or surgery. These "no-option" patients frequently have diffuse coronary disease without a discrete target for angioplasty, stenting, or surgical bypass. It has been estimated that Ͼ100 000 patients each year may fall beneath the no-option rubric. 1 Many of these patients have recently been investigational subjects in trials focused on angiogenesis by vascular growth factor infusions or laser injury.We suspect that gene therapy and laser revascularization strategies may have a fundamental flaw: the creation of new blood vessels in ischemic myocardial tissue requires significant arterial inflow, which is not obviously enhanced by these techniques. Therefore, we sought a novel percutaneous revascularization approach with the potential to provide robust arterial inflow to a sev...

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Evaluation of Regional Myocardial Nutrient Perfusion Following Selective Retrograde Arterialization of the Coronary Vein

Cited by 12 publications

References 15 publications

Lack of Durability of Surgical Arterialization of Coronary Veins for the Treatment of Ischemic Heart Disease

Lack of Durability of Surgical Arterialization of Coronary Veins for the Treatment of Ischemic Heart Disease

Correction of a saphenous vein graft to coronary vein anastamosis by selective retrograde coil‐induced occlusion to arterialize the native vein

Percutaneous In Situ Coronary Venous Arterialization

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