Intracoronary pharmacotherapy in the management of coronary microvascular dysfunction

Kunadian, Vijayalakshmi; Zorkun, Cafer; Williams, Scott; Biller, Leah H.; Palmer, Alexandra M.; Ogando, Katherine J.; Lew, Michelle; Nethala, Navin; Gibson, William J.; Marble, Susan J.; Buros, Jacqueline L.; Gibson, C. Michael

doi:10.1007/s11239-008-0276-0

Cited by 23 publications

(6 citation statements)

References 71 publications

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“…Generally, the cause of a no-reflow phenomenon is likely multifactorial due to a combination of endothelial damage, platelet and fibrin embolization, vasospasm, and extracellular or intracellular tissue edema, ultimately leading to neutrophil plugs and platelet infiltration of myocardial tissue and microcirculation injuries [19]. At first, very selective and distal intracoronary or intravenous vasodilator such as adenosine [20,21], nicorandil [22], nitroprusside, nicardipine, or verapamil [23,24] is tried. Otherwise, epinephrine may be helpful [25,26].…”

Section: Violation Of Duty Of Carementioning

confidence: 99%

Prevention of medical malpractice and disputes through analysis of lawsuits related to coronary angiography and intervention

Hyeon

Lee

Kim

et al. 2020

Korean J Intern Med

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Background/Aims: Possible fatal complications arising from coronary angiography (CAG), percutaneous coronary intervention (PCI), and coronary artery disease itself, are likely to cause medical disputes. Presenting the current status and reasons for judgments given in lawsuits related to CAG/PCI, this study aimed to identify ways to prevent unnecessary disputes and medical malpractice suits related to CAG/PCI through lawsuit analysis. Methods: A total of 13 cases (20 judgments) found in the Supreme Court of Korea's Written Judgment Management System from 1998 to 2017 were analyzed. Results: Coronary artery injury was the most common causative complication that led to lawsuits (n = 6, 46%). Six cases (46%) were ruled in favor of the plaintiff for violation of duty of care (n = 4) and duty of explanation (n = 2), respectively. Cases that violated duty of care included two errors in intra-procedure device manipulation, one in pre-procedure diagnosis, and one in management of post-procedure complication. Lack of explanation regarding the risk of complications was pointed out in both cases that violated duty of explanation. The average awarded amount for the damages was 114,436,064 Korean won. Conclusions: Physicians need not fear unfair judgments so long as they follow standard of care because the Court consistently looked at the probability, the foreseeability, and the evidence. Therefore, maintaining standard of care is important. Besides, specific, detailed, and comprehensible explanations, including the risk of complications in addition to the necessity of procedures, are important to ensure the patient clearly understands the possible risk of adverse outcomes.

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Section: Violation Of Duty Of Carementioning

confidence: 99%

Prevention of medical malpractice and disputes through analysis of lawsuits related to coronary angiography and intervention

Hyeon

Lee

Kim

et al. 2020

Korean J Intern Med

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“…164,165 Aggressive reduction of blood pressure through administration of high-dose calcium antagonists, β-blockers, or angiotensin-converting-enzyme inhibitors has shown promising effects in the reduction of final infarct size. 2,[166][167][168][169][170][171][172] Antiplatelet therapy For the acute care of patients with STEMI, clinical guidelines recommend the periprocedural administration of dual antiplatelet therapy and to consider maintenance therapy with a glycoprotein IIb/IIIa inhibitor. 173 Of note is that these drugs are associated with an increased risk of bleeding, because they aggressively reduce platelet reactivity to prevent thrombus formation.…”

Section: Reperfusion Strategiesmentioning

confidence: 99%

Intramyocardial haemorrhage after acute myocardial infarction

et al. 2014

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In patients with acute myocardial infarction (AMI), the guideline-recommended treatment is mechanical revascularization by percutaneous coronary intervention (PCI), which is effective at reducing mortality. However, a substantial proportion of patients with AMI develop chronic cardiac failure owing to poor restoration of microvascular function and myocardial perfusion, despite restoration of epicardial vessel patency. This occurrence is called the 'no-reflow' phenomenon. Although pathological and clinical observations initially seemed to support the hypothesis that no-reflow was the result of microvascular obstruction, irreversible microvascular injury and subsequent intramyocardial haemorrhage are now also thought to be important factors in this process. Intramyocardial haemorrhage shares several pathophysiological features with the haemorrhagic transformation that occurs after ischaemic stroke. Understanding of the role of intramyocardial haemorrhage in the no-reflow phenomenon and myocardial injury is crucial to the development of new therapeutic strategies to treat AMI. In this Review, we provide a comprehensive overview of the pathogenesis and clinical relevance of intramyocardial haemorrhage, and discuss diagnostic options and future therapeutic strategies.

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“…In the absence of an apparent thrombus or when only a small thrombus (corresponding to grades 1-2) is detected, the recommended PCI strategy includes standard pharmacotherapy, balloon angioplasty, and stenting. 39 Aspiration catheters can be useful as well in this situation. The management of a significant (grade 3) or heavy thrombotic burden (grades 4-5) is considerably more challenging.…”

Section: Indications For a Targeted Thrombus Strategymentioning

confidence: 99%