Reduced thrombus burden with abciximab delivered locally before percutaneous intervention in saphenous vein grafts

Gregory W. Barsness, Christopher Buller, E. Magnus Ohman, Elliot Schechter, Anthony Pucillo, Marc A. Taylor, Michael J. Miller, Jonathan S. Reiner, David Churchill, A. Bleakley Chandler, Mark Gonzalez, James Smith, Carl Tommaso, Lisa G. Berdan, Nancy M. Wildermann, David Hasdai, David Holmes

Research output: Contribution to journalArticle

46 Citations (Scopus)

Abstract

Background: Existing thrombus can complicate percutaneous saphenous vein graft (SVG) intervention. Local delivery of thrombolytics has been used to reduce the thrombus burden often associated with these interventions. We sought to determine whether local delivery of a platelet glycoprotein IIb/IIIa inhibitor is feasible and can reduce thrombus burden before percutaneous SVG intervention. Methods: We performed a multicenter pilot study of abciximab (0.25 mg/kg) given by local delivery catheter before percutaneous intervention for de novo SVG stenoses followed by intravenous infusion. All patients (n = 58) had ≥60% stenosis and Thrombolysis In Myocardial Infarction (TIMI) grade >0 flow in an SVG of 3 to 4 mm in diameter. Percent diameter stenosis, TIMI thrombus grade, and TIMI flow grade were measured before and after delivery of abciximab and after intervention. Results: Median percent diameter stenosis improved from 69% to 45% (P = .0001) after local delivery, and TIMI thrombus grade ≥ 1 incidence reduced from 68% to 34% (P = .0001). TIMI flow grade was not significantly affected (P = .12). All patients had a successful intervention (≤50% residual stenosis). Conclusions: Local abciximab delivery before percutaneous SVG intervention is associated with significantly reduced thrombus burden, significantly improved percent diameter stenosis, and excellent acute procedural results. Further studies of this approach are warranted to define its clinical utility.

Original languageEnglish (US)
Article numberS0002-8703(00)90014-0
Pages (from-to)824-829
Number of pages6
JournalAmerican Heart Journal
Volume139
Issue number5
DOIs
StatePublished - Jan 1 2000

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Saphenous Vein
Pathologic Constriction
Thrombosis
Transplants
Myocardial Infarction
Integrin beta3
Platelet Glycoprotein GPIIb-IIIa Complex
Intravenous Infusions
Multicenter Studies
abciximab
Catheters
Incidence

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Barsness, G. W., Buller, C., Ohman, E. M., Schechter, E., Pucillo, A., Taylor, M. A., ... Holmes, D. (2000). Reduced thrombus burden with abciximab delivered locally before percutaneous intervention in saphenous vein grafts. American Heart Journal, 139(5), 824-829. [S0002-8703(00)90014-0]. https://doi.org/10.1016/S0002-8703(00)90014-0

Reduced thrombus burden with abciximab delivered locally before percutaneous intervention in saphenous vein grafts. / Barsness, Gregory W.; Buller, Christopher; Ohman, E. Magnus; Schechter, Elliot; Pucillo, Anthony; Taylor, Marc A.; Miller, Michael J.; Reiner, Jonathan S.; Churchill, David; Chandler, A. Bleakley; Gonzalez, Mark; Smith, James; Tommaso, Carl; Berdan, Lisa G.; Wildermann, Nancy M.; Hasdai, David; Holmes, David.

In: American Heart Journal, Vol. 139, No. 5, S0002-8703(00)90014-0, 01.01.2000, p. 824-829.

Research output: Contribution to journalArticle

Barsness, GW, Buller, C, Ohman, EM, Schechter, E, Pucillo, A, Taylor, MA, Miller, MJ, Reiner, JS, Churchill, D, Chandler, AB, Gonzalez, M, Smith, J, Tommaso, C, Berdan, LG, Wildermann, NM, Hasdai, D & Holmes, D 2000, 'Reduced thrombus burden with abciximab delivered locally before percutaneous intervention in saphenous vein grafts', American Heart Journal, vol. 139, no. 5, S0002-8703(00)90014-0, pp. 824-829. https://doi.org/10.1016/S0002-8703(00)90014-0
Barsness GW, Buller C, Ohman EM, Schechter E, Pucillo A, Taylor MA et al. Reduced thrombus burden with abciximab delivered locally before percutaneous intervention in saphenous vein grafts. American Heart Journal. 2000 Jan 1;139(5):824-829. S0002-8703(00)90014-0. https://doi.org/10.1016/S0002-8703(00)90014-0
Barsness, Gregory W. ; Buller, Christopher ; Ohman, E. Magnus ; Schechter, Elliot ; Pucillo, Anthony ; Taylor, Marc A. ; Miller, Michael J. ; Reiner, Jonathan S. ; Churchill, David ; Chandler, A. Bleakley ; Gonzalez, Mark ; Smith, James ; Tommaso, Carl ; Berdan, Lisa G. ; Wildermann, Nancy M. ; Hasdai, David ; Holmes, David. / Reduced thrombus burden with abciximab delivered locally before percutaneous intervention in saphenous vein grafts. In: American Heart Journal. 2000 ; Vol. 139, No. 5. pp. 824-829.
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abstract = "Background: Existing thrombus can complicate percutaneous saphenous vein graft (SVG) intervention. Local delivery of thrombolytics has been used to reduce the thrombus burden often associated with these interventions. We sought to determine whether local delivery of a platelet glycoprotein IIb/IIIa inhibitor is feasible and can reduce thrombus burden before percutaneous SVG intervention. Methods: We performed a multicenter pilot study of abciximab (0.25 mg/kg) given by local delivery catheter before percutaneous intervention for de novo SVG stenoses followed by intravenous infusion. All patients (n = 58) had ≥60{\%} stenosis and Thrombolysis In Myocardial Infarction (TIMI) grade >0 flow in an SVG of 3 to 4 mm in diameter. Percent diameter stenosis, TIMI thrombus grade, and TIMI flow grade were measured before and after delivery of abciximab and after intervention. Results: Median percent diameter stenosis improved from 69{\%} to 45{\%} (P = .0001) after local delivery, and TIMI thrombus grade ≥ 1 incidence reduced from 68{\%} to 34{\%} (P = .0001). TIMI flow grade was not significantly affected (P = .12). All patients had a successful intervention (≤50{\%} residual stenosis). Conclusions: Local abciximab delivery before percutaneous SVG intervention is associated with significantly reduced thrombus burden, significantly improved percent diameter stenosis, and excellent acute procedural results. Further studies of this approach are warranted to define its clinical utility.",
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AU - Barsness, Gregory W.

AU - Buller, Christopher

AU - Ohman, E. Magnus

AU - Schechter, Elliot

AU - Pucillo, Anthony

AU - Taylor, Marc A.

AU - Miller, Michael J.

AU - Reiner, Jonathan S.

AU - Churchill, David

AU - Chandler, A. Bleakley

AU - Gonzalez, Mark

AU - Smith, James

AU - Tommaso, Carl

AU - Berdan, Lisa G.

AU - Wildermann, Nancy M.

AU - Hasdai, David

AU - Holmes, David

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N2 - Background: Existing thrombus can complicate percutaneous saphenous vein graft (SVG) intervention. Local delivery of thrombolytics has been used to reduce the thrombus burden often associated with these interventions. We sought to determine whether local delivery of a platelet glycoprotein IIb/IIIa inhibitor is feasible and can reduce thrombus burden before percutaneous SVG intervention. Methods: We performed a multicenter pilot study of abciximab (0.25 mg/kg) given by local delivery catheter before percutaneous intervention for de novo SVG stenoses followed by intravenous infusion. All patients (n = 58) had ≥60% stenosis and Thrombolysis In Myocardial Infarction (TIMI) grade >0 flow in an SVG of 3 to 4 mm in diameter. Percent diameter stenosis, TIMI thrombus grade, and TIMI flow grade were measured before and after delivery of abciximab and after intervention. Results: Median percent diameter stenosis improved from 69% to 45% (P = .0001) after local delivery, and TIMI thrombus grade ≥ 1 incidence reduced from 68% to 34% (P = .0001). TIMI flow grade was not significantly affected (P = .12). All patients had a successful intervention (≤50% residual stenosis). Conclusions: Local abciximab delivery before percutaneous SVG intervention is associated with significantly reduced thrombus burden, significantly improved percent diameter stenosis, and excellent acute procedural results. Further studies of this approach are warranted to define its clinical utility.

AB - Background: Existing thrombus can complicate percutaneous saphenous vein graft (SVG) intervention. Local delivery of thrombolytics has been used to reduce the thrombus burden often associated with these interventions. We sought to determine whether local delivery of a platelet glycoprotein IIb/IIIa inhibitor is feasible and can reduce thrombus burden before percutaneous SVG intervention. Methods: We performed a multicenter pilot study of abciximab (0.25 mg/kg) given by local delivery catheter before percutaneous intervention for de novo SVG stenoses followed by intravenous infusion. All patients (n = 58) had ≥60% stenosis and Thrombolysis In Myocardial Infarction (TIMI) grade >0 flow in an SVG of 3 to 4 mm in diameter. Percent diameter stenosis, TIMI thrombus grade, and TIMI flow grade were measured before and after delivery of abciximab and after intervention. Results: Median percent diameter stenosis improved from 69% to 45% (P = .0001) after local delivery, and TIMI thrombus grade ≥ 1 incidence reduced from 68% to 34% (P = .0001). TIMI flow grade was not significantly affected (P = .12). All patients had a successful intervention (≤50% residual stenosis). Conclusions: Local abciximab delivery before percutaneous SVG intervention is associated with significantly reduced thrombus burden, significantly improved percent diameter stenosis, and excellent acute procedural results. Further studies of this approach are warranted to define its clinical utility.

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