Pre-intervention intra-graft adenosine did not prevent slow-no reflow during saphenous vein graft interventions (14.2% vs 13.6%, P=0.9), but multiple rapid boluses effectively reversed it.
Cohort (n=143)
Single-blind
Does intra-graft adenosine prevent or reverse slow-no reflow during saphenous vein bypass graft interventions?
Intra-graft adenosine does not prevent slow-no reflow during saphenous vein graft interventions but effectively reverses it when administered in multiple rapid boluses.
Absolute Event Rate: 14.2% vs 13.6%
p-value: p=0.9
Slow or no reflow (SNR) complicates 10-15% of cases of percutaneous intervention (PI) in saphenous vein bypass graft (SVG). To date there have been limited options for the prevention and treatment of this common and potentially serious complication. We evaluated the procedural outcome of 143 consecutive SVG interventions. We compared patients who received pre-intervention intra-graft adenosine boluses with those who did not. In addition we examined the efficacy of adenosine boluses to reverse slow-no reflow events. Angiograms were reviewed and flow graded (TIMI grade) by film readers blinded to the use of any intraprocedural drug or clinical history. Seventy patients received intragraft adenosine boluses before percutaneous intervention (APPI), 73 received no preintervention adenosine (NoAPPI). There were no significant angiographic differences between the two groups at baseline. A total of 20 patients experienced SNR. The incidence of SNR was similar in the two groups (APPI = 14.2% vs. NoAPPI = 13.6%, P = 0.9). SNR was treated with repeated, rapid boluses (24 microg each) of intra-graft adenosine. Reversal of SNR was observed in 10 of 11 patients (91%) who received high doses of adenosine (>/=5 boluses, mean 7.7 +/- 2.6) and in 3 of 9 (33%) of those who received low doses (<5 boluses, mean 1.5 +/- 1.2). Final TIMI flow was significantly better in the high dose than in the low dose group (final TIMI 2.7 +/- 0.6 vs. 2 +/- 0.8, P = 0.04). No significant untoward complications were observed during adenosine infusion. These findings suggest that SNR after PI in SVG is not prevented by pre-intervention adenosine, but it can be safely and effectively reversed by delivery of multiple, rapid and repeated boluses of 24 microg of intra-graft adenosine.
Sdringola et al. (Sat,) conducted a cohort in Saphenous vein bypass graft (SVG) percutaneous intervention (n=143). Pre-intervention intra-graft adenosine vs. No pre-intervention adenosine was evaluated on Incidence of slow-no reflow (SNR) (p=0.9). Pre-intervention intra-graft adenosine did not prevent slow-no reflow during saphenous vein graft interventions (14.2% vs 13.6%, P=0.9), but multiple rapid boluses effectively reversed it.