論文

査読有り 国際誌
2019年12月15日

Usefulness of intracoronary administration of fasudil, a selective Rho-kinase inhibitor, for PCI-related refractory myocardial ischemia.

International journal of cardiology
  • Yoku Kikuchi
  • ,
  • Jun Takahashi
  • ,
  • Kiyotaka Hao
  • ,
  • Koichi Sato
  • ,
  • Jun Sugisawa
  • ,
  • Satoshi Tsuchiya
  • ,
  • Akira Suda
  • ,
  • Tomohiko Shindo
  • ,
  • Shohei Ikeda
  • ,
  • Takashi Shiroto
  • ,
  • Yasuharu Matsumoto
  • ,
  • Satoshi Miyata
  • ,
  • Yasuhiko Sakata
  • ,
  • Hiroaki Shimokawa

297
開始ページ
8
終了ページ
13
記述言語
英語
掲載種別
DOI
10.1016/j.ijcard.2019.09.057

BACKGROUND: Intra-procedural myocardial ischemia as an iatrogenic complication still remains a critical issue in contemporary interventional cardiology. The aim of this study was to examine the usefulness of fasudil, a selective Rho-kinase inhibitor, for percutaneous coronary intervention (PCI)-related myocardial ischemia. METHODS: Among 448 PCI sessions performed between October 2015 and December 2017, we retrospectively examined 36 patients (69.0 ± 9.1 [SD] yrs., M/F 26/10) who underwent intracoronary administration of fasudil during a procedure to resolve myocardial ischemia that was resistant to intracoronary nitrate administration. RESULTS: The refractory myocardial ischemia was caused by distal embolization (69%), enhanced vasoconstriction at distal site of chronic total occlusion (11%), coronary spasm (11%), and coronary dissection (8%), most of which occurred immediately after balloon or stent dilatation. Intracoronary fasudil significantly improved corrected TIMI frame count (from 37 [30-56] to 24 [12-36]) and TIMI flow grade (from 2 [1-2.5] to 3 [2-3]) (both P < 0.001). Finally, 86% of all subjects successfully obtained TIMI flow grade 3 at the end of the procedure. Intracoronary fasudil tended to be more effective in patients with an attenuated plaque detected by intravascular ultrasound. Importantly, among the 19 elective cases, fasudil successfully prevented 17 patients from developing post-procedure myocardial infarction. Although fasudil-induced transient hypotension requiring a vasopressor was noted in 22% of the subjects, no other adverse effects were noted. CONCLUSIONS: These results indicate that fasudil is a useful and safe therapeutic option for PCI-related myocardial ischemia refractory intracoronary nitrate.

リンク情報
DOI
https://doi.org/10.1016/j.ijcard.2019.09.057
PubMed
https://www.ncbi.nlm.nih.gov/pubmed/31611086
ID情報
  • DOI : 10.1016/j.ijcard.2019.09.057
  • PubMed ID : 31611086

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