LGE-cMRI assessment of volume controlled reperfusion method in primary percutaneous coronary intervention in patients with ST elevated myocardial infarction

Abstract

Abstract Objectives We create a procedure based on postconditioning and gradual reperfusion, “Volume Controlled Reperfusion Revascularization” method (VCR)in primary percutaneous coronary intervention. The aim of this experimental study is to assess feasibility and effect of VCR and if this method will attenuate reperfusion injury in microvascular obstruction. Methods VCR method, Basically, contemporaneous forward blood flow balloon inflation blocking at the occlusion site and prolonged distal reperfusion via aspiration catheter. Active NC balloon inflation at occlusion site, while keeping NC balloon inflation, aspiration catheter was positioned 10–15mm advanced of NC balloon, intra-aspiration catheter infusion of mixture solution (artery blood 10ml+ heparin NS 10ml), 20ml/min for 10mins, adjust volume and speed according to blood pressure and heart rate variation. Stent or DCB as usual. After several successful operation on RCA, 10 patients with acute ST-segment elevation myocardial infarction (STEMI)with angiography confirmed proximal complete occlusion on dominant blood vessel were non-randomly enrolled (symptom to angiography <12h). 5 cases in VCR group with volume-controlled reperfusion revascularization method, 5 cases in control group with conventional PCI method. Microvascular obstruction (MVO) has been calculated by late gadolinium-enhanced cardiovascular magnetic resonance (LGE-cMRI). Base line information, angiographic features before and after procedure, in-hospital status and MVO were compared. Results Successful PCI procedure, safe in-hospital treatment and LGE-cMRI assessment for MVO. Group difference were found in age group and PCI to MRI interval (53.8±7.6 vs 70.2±4.44, P=0.0031; 7.4±2.3 vs 10.4±1.67, P=0.046) between VCR and control group, respectively. There was no statistic difference in other base line information, peak myocardial enzyme, and BNP. MVO and MVO mass ratio was significantly lower in VCR group (0.78±0.96 vs 2.80±1.37, P=0.0317; 0.00585±0.00080 vs 0.02493±0.01501, P=0.0372). TIMI III blood flow found in VCR group. Re-myocardial infraction nor target vessel revascularization was documented in-hospital or 30-days follow up. Conclusion Among the selected small sample cases, volume-controlled reperfusion method procedure was clinical safe and feasible without additional side effect. TIMI III blood flow and less MVO were documented. Funding Acknowledgement Type of funding sources: None. LGE-cMRI results in VCR and controlCase illustration of VCR procedure