Treatment of no-reflow in degenerated saphenous vein graft interventions: Comparison of intracoronary verapamil and nitroglycerin

Barry M. Kaplan, Keith H. Benzuly, James W. Kinn, Terry R. Bowers, Frank V. Tilli, Cindy L. Grines, William W. O'Neill, Robert D. Safian*

*Corresponding author for this work

Research output: Contribution to journalArticle

122 Scopus citations

Abstract

No-fellow has been reported after 10-15% of percutaneous interventions on degenerated saphenous vein grafts. In this prospective study of 36 degenerated saphenous vein graft lesions (32 patients), no-reflow (TIMI flow <3 in the absence of a significant lesion or dissection) occurred in 15/36 (42%) lesions. A total of 32 episodes of no-reflow occurred after angioscopy (n = 14), extraction atherectomy (n = 10), balloon angioplasty (n = 2) or stent implantation (n = 6). Intragraft nitroglycerin (100-300 μg) alone resulted in no improvement in TIMI flow in the setting of no-reflow (TIMI flow 1.2 ± 0.6 to 1.4 ± 0.8, P = NS). Intragraft verapamil (100-500 μg) resulted in improvement in flow in all 32 episodes (TIMI flow 1.4 ± 0.8 before, to 2.8 ± 0.5 after verapamil, P < 0.001). Although verapamil increased TIMI flow after all episodes of no-reflow, two (6.3%) had persistent no-reflow (TIMI 1) despite verapamil, associated with non-Q wave myocardial infarction. In conclusion, treatment of no-reflow with verapamil during degenerated vein graft interventions was associated with reestablishment of TIMI 3 flow in 88% of cases. In contrast, intragraft nitroglycerin alone was ineffective for reversing no-reflow.

Original languageEnglish (US)
Pages (from-to)113-118
Number of pages6
JournalCatheterization and cardiovascular diagnosis
Volume39
Issue number2
DOIs
StatePublished - Oct 1996
Externally publishedYes

Keywords

  • no-reflow
  • vein graft
  • verapamil

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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