Intense Vasoconstriction in Response to Aspirate From Stented Saphenous Vein Aortocoronary Bypass Grafts

Leineweber, Kirsten; Böse, Dirk; Vogelsang, Magdalene; Haude, Michael; Erbel, Raimund; Heusch, Gerd

doi:10.1016/j.jacc.2005.10.053

Cited by 54 publications

(43 citation statements)

References 31 publications

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“…We detected a release of the soluble mediators serotonin, TxB 2 , and TNF␣ into the aspirate of nRCA and SVG-RCA, confirming our prior studies in SVG lesions (2,16,21). However, the release of these mediators was comparable between nRCA and SVG-RCA.…”

Section: Discussionsupporting

confidence: 89%

Aspirate from human stented native coronary arteries vs. saphenous vein grafts: more endothelin but less particulate debris

Kleinbongard

Baars

Möhlenkamp

et al. 2013

American Journal of Physiology-Heart and Circulatory Physiology

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Kleinbongard P, Baars T, Möhlenkamp S, Kahlert P, Erbel R, Heusch G. Aspirate from human stented native coronary arteries vs. saphenous vein grafts: more endothelin but less particulate debris. Am J Physiol Heart Circ Physiol 305: H1222-H1229, 2013. First published August 9, 2013; doi:10.1152/ajpheart.00358.2013.-Stent implantation into atherosclerotic coronary arteries releases particulate debris and soluble substances that contribute to impaired microvascular perfusion. Here we addressed the potential for microvascular obstruction in patients with stenotic native right coronary arteries (nRCA) compared with saphenous vein grafts on right coronary arteries (SVG-RCA). We enrolled symptomatic, male patients with stable angina pectoris and a flow-limiting stenosis in their nRCA or SVG-RCA (n ϭ 18/18). Plaque volume and composition were analyzed using intravascular ultrasound before stent implantation. Coronary aspirate was retrieved during stent implantation under protection with a distal occlusion/aspiration device and divided into particulate debris and plasma. The release of catecholamines, endothelin, serotonin, thromboxane B2, and tumor necrosis factor-␣ was measured. The response of rat mesenteric arteries with intact (ϩE) and denuded (ϪE) endothelium to aspirate plasma (without and with selective endothelin receptor blockade) was normalized to that by potassium chloride (KClmax ϭ 100%). Plaque volume and composition were not different between nRCA and SVG-RCA. There was less particulate debris (65 Ϯ 8 vs. 146 Ϯ 23 mg; P Ͻ 0.05) and more endothelin release (5.8 Ϯ 0.8 vs. 1.3 Ϯ 0.7 pg/ml; P Ͻ 0.05) in nRCA than in SVG-RCA, whereas the release of the other mediators was not different. Aspirate from nRCA induced stronger vasoconstriction than that from SVG-RCA [nRCA, 78 Ϯ 6% (ϩE)/84 Ϯ 5% (ϪE); SVG-RCA, 59 Ϯ 6% (ϩE)/68 Ϯ 3% (ϪE); P Ͻ 0.05 nRCA vs. SVG-RCA], which was attenuated by a nonspecific endothelin and a specific endothelin receptor A antagonist. Thus coronary aspirate from stented nRCA is characterized by less debris but more endothelin and stronger vasoconstrictor response than that from SVG-RCA. coronary disease; ischemia; native coronary artery; saphenous vein graft; vasoconstriction INTERVENTIONAL PLAQUE RUPTURE induces the release of not only particulate debris but also soluble vasoconstrictor, thrombogenic, and inflammatory substances from the lesion that all contribute to impair microvascular coronary perfusion. Typical consequences of coronary microvascular obstruction are microinfarcts with subsequent inflammation, arrhythmias, contractile dysfunction, and impaired coronary flow reserve (14). Various protection devices have been used to capture and remove the released plaque material. A prognostic benefit from distal protection devices in elective interventions has been established only for saphenous vein grafts (SVGs) (3, 39), whereas a benefit for native coronary arteries still remains to be demonstrated (14).The underlying atherosclerosis in native coronary arteries differs from that in SVGs,...

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Section: Discussionsupporting

confidence: 89%

Aspirate from human stented native coronary arteries vs. saphenous vein grafts: more endothelin but less particulate debris

Kleinbongard

Baars

Möhlenkamp

et al. 2013

American Journal of Physiology-Heart and Circulatory Physiology

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“…In fact, plaque volume is directly related to the amount of coronary vasoconstrictor released. 27 It is also unclear whether the nature of the embolizing plaque material (fibrotic debris with cholesterol versus fresh thrombotic material) has an effect on the consequences of coronary microembolization.…”

Section: Pathophysiology Of Coronary Microembolization Morphologymentioning

confidence: 99%

“…Several vasodilator agents, such as nitroprusside, verapamil, and adenosine, have been shown to improve microcirculatory flow with varying degrees of success. 57 The recognition that thromboxane A 2 and serotonin are released from rupturing plaques 27 may provide a potential new treatment option.…”

Section: No-reflow Phenomenonmentioning

confidence: 99%

“…71,72 It is unclear whether such inflammatory biomarkers originate from the rupturing atherosclerotic plaque, the microcirculatory inflammation in response to the myocardial infarcts, or both. 73 Clearly, the rupturing atherosclerotic plaque results not only in the release of vasoconstrictor and thrombogenic soluble factors that contribute to impaired microvascular perfusion 27,74,75 but also in the release of TNF-␣ 76 ; these factors can be retrieved by use of a distal balloon occlusion/aspiration protection device in patients undergoing PCI. 27,76 Direct stenting without balloon predilation attenuates troponin release and microvascular dysfunction.…”

Section: Diagnosis Of Coronary Microembolization Biomarkers and Solubmentioning

confidence: 99%

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Coronary Microembolization

et al. 2009

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Abstract-Coronary microembolization from the erosion or rupture of a vulnerable atherosclerotic plaque occurs spontaneously in acute coronary syndromes and iatrogenically during percutaneous coronary interventions. Typical consequences of coronary microembolization are microinfarcts with an inflammatory response, contractile dysfunction, and reduced coronary reserve. Apart from transient elevations of creatine kinase and troponin, microemboli can be visualized by intracoronary Doppler and the resulting microinfarcts by late-enhancement nuclear magnetic resonance. Statins, antiplatelet agents, and coronary vasodilators protect against microembolization and microinfarction when started before percutaneous coronary interventions. Distal protection devices can retrieve atherothrombotic debris and prevent its embolization into the microcirculation, but their effect on clinical outcome has been disappointing so far, except for saphenous vein bypass grafts. Devices for aspiration of thrombi and thrombus-derived vasoconstrictor, thrombogenic, and inflammatory substances, however, reduce thrombus burden, improve perfusion, and provide protection in patients with acute myocardial infarction. Key Words:he rupture of an atherosclerotic plaque in an epicardial coronary artery does not always result in complete thrombotic coronary occlusion and impending myocardial infarction; milder forms of plaque rupture may leave some residual blood flow and result in the washout of atherothrombotic debris into the coronary microcirculation and its subsequent embolization. Coronary microembolization became a focus of attention about a decade ago with the awareness that coronary microembolization and its sequelae are a frequent iatrogenic complication of percutaneous coronary interventions (PCIs). 1,2 However, coronary microembolization was recognized much earlier as being the underlying pathophysiological event in sudden death of patients with unstable angina. [3][4][5][6] The present review summarizes and updates the pathophysiology of coronary microembolization and the clinical evidence for its diagnosis and its prevention.The incidence of coronary microembolization is difficult to judge. Spontaneous coronary microembolization occurs, but most likely, only the tip of the iceberg is recognized. Periprocedural coronary microembolization occurs on average in 25% of all PCIs, but its incidence ranges from 0% to 70%, in part depending on the method of its assessment. 7 The incidence of periprocedural coronary microembolization depends on factors related to the clinical condition of the patient, notably preexisting kidney disease or underlying unstable angina; factors related to the length 8 or complexity of the lesion; and finally, factors related to the procedure, notably the use of a stent rather than percutaneous transluminal coronary angioplasty, the number and duration of inflations, and particularly the use of atherectomy and rotablation. 7 In patients with an acute myocardial infarction, an angiographic distal filling defect occurred ...

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“…Ganz im Vordergrund steht dabei die Differenzierung von vulnerablen Plaques, die anhand eines großen nekrotischen Lipidkerns und eines positiven Remodellings sowie einer lumennahen Position des Lipidkerns identifiziert werden kön-nen [13,14,15]. Dies war die Grundlage für die Aufdeckung neuer Mechanismen der Pathogenese der Atherosklerose und der Begleitreaktionen bei Interventionen, die auf Mikroembolisierungen zurückge-führt werden können [16,17].…”

Section: Fortschritte Der Diagnostik Sind Die Treibende Kraft Für Dieunclassified

Fortschritte der Diagnostik sind die treibende Kraft für die Weiterentwicklung interventioneller Verfahren

Erbel

2011

Herz

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Intense Vasoconstriction in Response to Aspirate From Stented Saphenous Vein Aortocoronary Bypass Grafts

Abstract: Stent implantation releases, apart from and in addition to particulate debris, soluble vasoconstrictor substances that possibly contribute to impaired microvascular perfusion.

Cited by 54 publications

References 31 publications

Aspirate from human stented native coronary arteries vs. saphenous vein grafts: more endothelin but less particulate debris

Aspirate from human stented native coronary arteries vs. saphenous vein grafts: more endothelin but less particulate debris

Coronary Microembolization

Fortschritte der Diagnostik sind die treibende Kraft für die Weiterentwicklung interventioneller Verfahren

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