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العنوان
Local Delivery of GPIIb/IIIa Inhibitors
versus Intracoronary Administration
via the Guiding Catheter in ACS
Patients /
المؤلف
Mohamed, Salwa Labib Farid.
هيئة الاعداد
باحث / سلوي لبيب فريد محمد
مشرف / طارق منير ذكى
مشرف / ماجد منصور العبادي
مناقش / وائل مصطفى النماس
تاريخ النشر
2011
عدد الصفحات
152p :
اللغة
الإنجليزية
الدرجة
ماجستير
التخصص
أمراض القلب والطب القلب والأوعية الدموية
تاريخ الإجازة
1/1/2011
مكان الإجازة
جامعة عين شمس - كلية الطب - القلب والاوعية الدموية
الفهرس
Only 14 pages are availabe for public view

from 169

from 169

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.