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Abstract Acute coronary syndromes are common phenomena nowadays. plaque rupture and thrombosis leading to myocardial ischemia. Percutaneous coronary intervention (PCI) is often the primary therapy. Before the era of glycoprotein (GP) IIb/IIIa inhibitors, PCI was associated with a major adverse cardiac event rate of IIb/IIIa inhibitor eptifibatide has been demonstrated to improve cardiac outcomes among patients with PCI by reducing the occurrence of major adverse cardiac events. Despite this improvement in outcomes, micro complicate P angiographically evident vessel obstruction. Thrombus and vascular debris may embolize and lead to plugging of the microvasculature, microvascular dysfunction, and eventually myocardial necrosis. GP IIb/IIIa antagonists at elevated local concentrations may enhance thrombus disaggregation by disrupting 122 Summary They are caused by 10% to 12%.The GP micro-infarcts may still PCI in the absence of al CI Summary platelet crosslinking. Indeed, higher levels of platelet GP IIb/IIIa receptor occupancy with eptifibatide have been associated with improved myocardial perfusion among patients with ST infarction. Thus, local administration of eptifibatide may result in much higher local concentration, which may lead to increased levels of platelet GP IIb/IIIa receptor occupancy, destabilization of platelet aggregates, and promotion of disaggregation in the epicardial artery and microvasculature, possibly offering the potential of improving myocardial perfusion. Eptifibatide has been shown to be safe in intracoronary administration in acute coronary syndromes. Local intracoronar eptifibatide & vasodilators in patients with acute coronary syndrome undergoing stent implantation is proposed, which might result in a better angiographic and clinical outcome. Our study demonstrated that an IC bolus of eptifibatide 123 ST-elevation myocardial thrombus intracoronary bolus administration of delivered with the vation y Summary ClearWay™RX catheter resulted in significant additional clot resolution in vivo when compared with a conventional intracoronary administration. The primary endpoint chosen to evaluate this hypothesis was post procedural frequency o grade secondary end point was Composite of Death, Re revascularization randomization. In our study, the primary endpoint was achieved, and patients who were treated with intra-lesional ClearWay™ integrilin experienced a statistically significant reduction in angiographic post blush grade 0/I Additionally points (death, infarction and TVR) was significantly higher in the conventional arm as well as the recurrent ischemia in the same territory. These findings correlate with other published studies and could explain some of the improved results in those patients receiving intra glycoprotein (GP) IIb/IIIa inhibitor via the ClearWay drug delivery balloon. Furthermore The Clinical study suggest patients who received intra lesional ClearWay RX integrilin were 124 of blush Re-infarction and Target vessel 30 days from Additionally, the composite of 2ry end intra-lesional findings of this f ry intralesional Summary strongly associated with better outcomes, including significantly better blush grade and lower composite of major adverse cardiac events compared to patients w did not receive ClearWay RX integrilin. Overall, these findings suggest the efficacy of local drug delivery to enhance the contact of integrilin with the plaque components and imply that the wash the drug is one of the potential mechanisms to explain why rates of slow flow remain high in lesions with high thrombotic burden, despite intracoronary integrilin administration via the guiding catheter. The results of this randomized trial emphasized that, in patients with acute coronary syndrome and ev thrombus in the culprit lesion undergoing percutaneous coronary intervention and downstream clopidogrel administration, local delivery of integrilin at the site of the athero-thrombotic plaque through a dedicated catheter yields a greater dissolution of the thrombus burden than conventional intracoronary bolus administration. |