Selective Intracoronary Hypothermia in Percutaneous Coronary Intervention: Current Evidence, Challenges, and Future Directions

Selective intracoronary hypothermia (SICH) is a promising therapeutic approach aimed at mitigating ischemia-reperfusion injury (IRI) in patients undergoing percutaneous coronary intervention (PCI), a procedure used to address blocked or narrowed coronary arteries. This technique involves the infusion of cooled saline or cardioplegic solutions directly into the coronary arteries near the lesion, inducing localized cooling of myocardial tissue to protect against damage caused by the restoration of blood flow. Early studies indicate that SICH is a safe and feasible method that may potentially reduce infarct size and enhance myocardial recovery. However, the clinical implementation of SICH is currently limited due to certain challenges including the need for specialized equipment, the risk of cooling-related complications such as arrhythmias, and the requirement for precise temperature control. Furthermore, the ideal temperature and duration for effective cooling remain unclear. Addressing these challenges, future investigations should prioritize large-scale, long-term trials focusing on the long-term effects of SICH on patient outcomes such as infarct size, cardiac function, and survival to confirm the efficacy and safety of this therapy. Additionally, comparative studies with other established reperfusion strategies are also required to evaluate the relative effectiveness of SICH and optimize its use during PCI.