The effect of electrical neurostimulation on collateral perfusion during acute coronary occlusion

Jessica De Vries,Eng-Shiong Tan,Michiel J Staal,Bart Jgl De Smet,Mike Jl Dejongste,Gillian A Jessurun,Felix Zijlstra,Ad Fm Van Den Heuvel,Rutger L Anthonio

doi:10.1186/1471-2261-7-18

Jessica De Vries, Eng-Shiong Tan + Show 7 more

Open Access

https://doi.org/10.1186/1471-2261-7-18

Copy DOI

Abstract

BackgroundElectrical neurostimulation can be used to treat patients with refractory angina, it reduces angina and ischemia. Previous data have suggested that electrical neurostimulation may alleviate myocardial ischaemia through increased collateral perfusion. We investigated the effect of electrical neurostimulation on functional collateral perfusion, assessed by distal coronary pressure measurement during acute coronary occlusion. We sought to study the effect of electrical neurostimulation on collateral perfusion.MethodsSixty patients with stable angina and significant coronary artery disease planned for elective percutaneous coronary intervention were split in two groups. In all patients two balloon inflations of 60 seconds were performed, the first for balloon dilatation of the lesion (first episode), the second for stent delivery (second episode). The Pw/Pa ratio (wedge pressure/aortic pressure) was measured during both ischaemic episodes. Group 1 received 5 minutes of active neurostimulation before plus 1 minute during the first episode, group 2 received 5 minutes of active neurostimulation before plus 1 minute during the second episode.ResultsIn group 1 the Pw/Pa ratio decreased by 10 ± 22% from 0.20 ± 0.09 to 0.19 ± 0.09 (p = 0.004) when electrical neurostimulation was deactivated. In group 2 the Pw/Pa ratio increased by 9 ± 15% from 0.22 ± 0.09 to 0.24 ± 0.10 (p = 0.001) when electrical neurostimulation was activated.ConclusionElectrical neurostimulation induces a significant improvement in the Pw/Pa ratio during acute coronary occlusion.

Highlights

Electrical neurostimulation can be used to treat patients with refractory angina, it reduces angina and ischemia
The settings of electrical neurostimulation were similar in the two groups, with a motor threshold in group 1 of 7.8 ± 2.7 mA, and in group 2 of 7.3 ± 2.1 mA (p = 0.57)
Intra Coronary (IC) Pressure measurements The Pd/Pa ratio was similar in the two groups (0.77 ± 0.22 and 0.74 ± 0.23, p = 0.59)

Summary

Introduction

Electrical neurostimulation can be used to treat patients with refractory angina, it reduces angina and ischemia. Previous data have suggested that electrical neurostimulation may alleviate myocardial ischaemia through increased collateral perfusion. We sought to study the effect of electrical neurostimulation on collateral perfusion. Coronary artery bypass grafting (CABG) are established revascularization modalities, yet for some patients PCI and CABG are not an option, or do not result in com-. BMC Cardiovascular Disorders 2007, 7:18 http://www.biomedcentral.com/1471-2261/7/18 plete revascularization. The report of the ESC joint study group for refractory angina define refractory angina as a chronic condition which cannot be controlled by medical therapy nor by revascularization, with an estimated prevalence of 30–50 000 patients/year in Europe [1]. Small randomized trials have demonstrated a safe reduction in angina by electrical neurostimulation, enabling patients to prolong exercise without aggravating myocardial ischaemia. Small randomized trials have demonstrated a safe reduction in angina by electrical neurostimulation, enabling patients to prolong exercise without aggravating myocardial ischaemia. [2,3,4,5,6]

Methods

Results

Conclusion