The relationship of intracoronary stent placement following thrombolytic therapy to tissue level perfusion

C. M. Gibson, D. Frisch, S. A. Murphy, S. G. Gourlay, Raymond J Gibbons, K. W. Baran, M. Nguyen, S. Palmeri, H. V. Barron

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background: Stenting has been shown to improve lumen diameters and thereby improve epicardial blood flow, but the impact of stent placement on tissue level perfusion has not been well characterized. Methods: Data were drawn from the LIMIT trial of rhuMAb CD18 (anti WBC antibody) in acute myocardial infarction (AMI). Adjunctive/rescue stenting was performed at the discretion of the investigator. The TIMI Myocardial Perfusion Grade (TMPG) was assessed and digital subtraction angiography (DSA) was used to quantify brightness of the myocardial blush. Results: TIMI 3 flow was 54.2% (64/118) before stent placement, and improved to 87.2% (102/117, p < 0.001) following stent placement. Likewise, Corrected TIMI Frame Counts (CTFCs) improved from medians of 37.6 to 21 (p < 0.001). By DSA, the rate of growth in brightness also tended to be greater after stenting (2.3 ± 0.4 Gray/sec, n = 54 vs 3.1 ± 0.3, n = 54, p = 0.07). The incidence of TMPG 0 decreased following stent placement (25.2% (29/118) vs 14.3% (16/118), p = 0.03) and the incidence of a stain in the myocardium (TMPG 1) increased (13.5% (16/118) vs 28.6% (34/118), p = 0.004). Conclusion: Adjunctive stenting following thrombolytic administration in AMI improves epicardial TIMI 3 flow and TIMI frame counts as well as dye inflow into the myocardium: TMPG 0 is reduced and myocardial blush measured quantitatively by DSA tends to be brighter. However, more TMPG 1 or dye staining was present on next injection, suggesting dye outflow may be impaired.

Original languageEnglish (US)
Pages (from-to)63-68
Number of pages6
JournalJournal of Thrombosis and Thrombolysis
Volume13
Issue number2
DOIs
StatePublished - 2002

Fingerprint

Thrombolytic Therapy
Stents
Perfusion
Digital Subtraction Angiography
Coloring Agents
Myocardium
Myocardial Infarction
Incidence
Anti-Idiotypic Antibodies
Research Personnel
Staining and Labeling
Injections
Growth

Keywords

  • Acute myocardial infarction
  • Microvasculature
  • Stent
  • TIMI frame count
  • TIMI myocardial perfusion grade

ASJC Scopus subject areas

  • Hematology
  • Cardiology and Cardiovascular Medicine

Cite this

The relationship of intracoronary stent placement following thrombolytic therapy to tissue level perfusion. / Gibson, C. M.; Frisch, D.; Murphy, S. A.; Gourlay, S. G.; Gibbons, Raymond J; Baran, K. W.; Nguyen, M.; Palmeri, S.; Barron, H. V.

In: Journal of Thrombosis and Thrombolysis, Vol. 13, No. 2, 2002, p. 63-68.

Research output: Contribution to journalArticle

Gibson, CM, Frisch, D, Murphy, SA, Gourlay, SG, Gibbons, RJ, Baran, KW, Nguyen, M, Palmeri, S & Barron, HV 2002, 'The relationship of intracoronary stent placement following thrombolytic therapy to tissue level perfusion', Journal of Thrombosis and Thrombolysis, vol. 13, no. 2, pp. 63-68. https://doi.org/10.1023/A:1016253028348
Gibson, C. M. ; Frisch, D. ; Murphy, S. A. ; Gourlay, S. G. ; Gibbons, Raymond J ; Baran, K. W. ; Nguyen, M. ; Palmeri, S. ; Barron, H. V. / The relationship of intracoronary stent placement following thrombolytic therapy to tissue level perfusion. In: Journal of Thrombosis and Thrombolysis. 2002 ; Vol. 13, No. 2. pp. 63-68.
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abstract = "Background: Stenting has been shown to improve lumen diameters and thereby improve epicardial blood flow, but the impact of stent placement on tissue level perfusion has not been well characterized. Methods: Data were drawn from the LIMIT trial of rhuMAb CD18 (anti WBC antibody) in acute myocardial infarction (AMI). Adjunctive/rescue stenting was performed at the discretion of the investigator. The TIMI Myocardial Perfusion Grade (TMPG) was assessed and digital subtraction angiography (DSA) was used to quantify brightness of the myocardial blush. Results: TIMI 3 flow was 54.2{\%} (64/118) before stent placement, and improved to 87.2{\%} (102/117, p < 0.001) following stent placement. Likewise, Corrected TIMI Frame Counts (CTFCs) improved from medians of 37.6 to 21 (p < 0.001). By DSA, the rate of growth in brightness also tended to be greater after stenting (2.3 ± 0.4 Gray/sec, n = 54 vs 3.1 ± 0.3, n = 54, p = 0.07). The incidence of TMPG 0 decreased following stent placement (25.2{\%} (29/118) vs 14.3{\%} (16/118), p = 0.03) and the incidence of a stain in the myocardium (TMPG 1) increased (13.5{\%} (16/118) vs 28.6{\%} (34/118), p = 0.004). Conclusion: Adjunctive stenting following thrombolytic administration in AMI improves epicardial TIMI 3 flow and TIMI frame counts as well as dye inflow into the myocardium: TMPG 0 is reduced and myocardial blush measured quantitatively by DSA tends to be brighter. However, more TMPG 1 or dye staining was present on next injection, suggesting dye outflow may be impaired.",
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AU - Frisch, D.

AU - Murphy, S. A.

AU - Gourlay, S. G.

AU - Gibbons, Raymond J

AU - Baran, K. W.

AU - Nguyen, M.

AU - Palmeri, S.

AU - Barron, H. V.

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AB - Background: Stenting has been shown to improve lumen diameters and thereby improve epicardial blood flow, but the impact of stent placement on tissue level perfusion has not been well characterized. Methods: Data were drawn from the LIMIT trial of rhuMAb CD18 (anti WBC antibody) in acute myocardial infarction (AMI). Adjunctive/rescue stenting was performed at the discretion of the investigator. The TIMI Myocardial Perfusion Grade (TMPG) was assessed and digital subtraction angiography (DSA) was used to quantify brightness of the myocardial blush. Results: TIMI 3 flow was 54.2% (64/118) before stent placement, and improved to 87.2% (102/117, p < 0.001) following stent placement. Likewise, Corrected TIMI Frame Counts (CTFCs) improved from medians of 37.6 to 21 (p < 0.001). By DSA, the rate of growth in brightness also tended to be greater after stenting (2.3 ± 0.4 Gray/sec, n = 54 vs 3.1 ± 0.3, n = 54, p = 0.07). The incidence of TMPG 0 decreased following stent placement (25.2% (29/118) vs 14.3% (16/118), p = 0.03) and the incidence of a stain in the myocardium (TMPG 1) increased (13.5% (16/118) vs 28.6% (34/118), p = 0.004). Conclusion: Adjunctive stenting following thrombolytic administration in AMI improves epicardial TIMI 3 flow and TIMI frame counts as well as dye inflow into the myocardium: TMPG 0 is reduced and myocardial blush measured quantitatively by DSA tends to be brighter. However, more TMPG 1 or dye staining was present on next injection, suggesting dye outflow may be impaired.

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KW - Microvasculature

KW - Stent

KW - TIMI frame count

KW - TIMI myocardial perfusion grade

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