Intracoronary Administration of Drugs in Clinical Practice

DOI: https://doi.org/10.30702/ujcvs/22.30(04)/SS051-1219
Keywords: phenomenon of distal microembolization, no-reflow, drug delivery, adenosine, antiplatelet therapy

Abstract

Intracoronary administration of drugs allows to achieve the fastest possible effect in interventional cardiology. This allows to avoid all the biological filters of the body and achieve the required concentration of the active substance at the injection site. Also, given the local action, systemic side effects are nearly absent.

The aim. To study the literature data of the leading countries of the world in the field of intracoronary drug administration. To analyze the experience of different centers on the use of various medications in the treatment of the phenomenon of distal microembolization.

Results. One of the first drugs administered intracoronary was streptokinase for the treatment of acute myocardial infarction. After that, it became clear that this method of delivering drugs is possible and can be used. With the beginning of the treatment of acute coronary syndromes by stenting, one of the possible complications arose in the form of no-reflow. At the same time, realizing that this is a local problem, they began to use the possibility of intracoronary administration of drugs to treat this phenomenon. The main advantage of this method is quick response to drug administration. Today, the drugs of choice in the treatment of no-reflow are verapamil, adenosine, nitroprusside, adrenaline. On the other hand, probably the most common drug that is administered intracoronary is nitroglycerin. It is used as a vasodilator in the event of spasm of the coronary arteries. Subsequently, it has been recommended to deliver drugs via a microcatheter or aspiration catheter to achieve even more selective effect in the area of the affected vessel, and this also minimizes drug loss due to coronary reflux into the aortic sinuses while usinga guiding catheter. Work is also underway on the use of intracoronary insulin in acute coronary syndrome in order to reduce the area of damage in myocardial infarction. It is also very promising to study the introduction of stem cells directlyinto the myocardium through a microcatheter in order to regenerate the myocardium after a heart attack.

Conclusions. Intracoronary administration of drugs allows to achieve the maximum effect in the shortest possible time. Today, many drugs can be used in this way, starting from the treatment of the phenomenon of distal microembolization and ending with myocardial regeneration after myocardial infarction.

References

  1. Jones DA, Pellaton C, Velmurugan S, Rathod KS, Andiapen M, Antoniou S, et al. Randomized Phase 2 Trial of Intracoronary Nitrite During Acute Myocardial Infarction. Circ Res. 2015;116(3):437-47. https://doi.org/10.1161/CIRCRESAHA.116.305082
  2. Desmet W, Bogaert J, Dubois C, Sinnaeve P, Adriaenssens T, Pappas C, et al. High-dose intracoronary adenosine for myocardial salvage in patients with acute ST-segment elevation myocardial infarction. Eur Heart J. 2011;32(7):867-77. https://doi.org/10.1093/eurheartj/ehq492
  3. Rentrop KP, Blanke H, Karsch KR, Wiegand V, Kostering H, Oster H, et al. Acute myocardial infarction: intracoronary application of nitroglycerin and streptokinase. Clin Cardiol. 1979;2(5):354-63. https://doi.org/10.1002/clc.4960020507
  4. Lo YS. Intravenous versus intracoronary streptokinase in acute myocardial infarction. Clin Cardiol. 1985;8(12):609-19. https://doi.org/10.1002/clc.4960081202
  5. Koren G, Weiss AT, Hasin Y, Appelbaum D, Welber S, Rozenman Y, et al. Prevention of Myocardial Damage in Acute Myocardial Ischemia by Early Treatment with Intravenous Streptokinase. N Engl J Med. 1985;313(22):1384-9. https://doi.org/10.1056/NEJM198511283132204
  6. Hillis LD, Borer J, Braunwald E, Chesebro JH, Cohen LS, Dalen J, et al. High dose intravenous streptokinase for acute myocardial infarction: preliminary results of a multicenter trial. J Am Coll Cardiol. 1985;6(5):957-62. https://doi.org/10.1016/s0735-1097(85)80294-1
  7. Simoons ML, Serruys PW, vd Brand M, Bar F, de Zwaan C, Res J, et al. Improved survival after early thrombolysis in acute myocardial infarction. A randomised trial by the Interuniversity Cardiology Institute in The Netherlands. Lancet. 1985;2(8455):578-82. https://doi.org/10.1016/s0140-6736(85)90584-7
  8. Burket MW, Smith MR, Walsh TE, Brewster PS, Fraker TD Jr. Relation of effectiveness of intracoronary thrombolysis in acute myocardial infarction to systemic thrombolytic state. Am J Cardiol. 1985;56(7):441-4. https://doi.org/10.1016/0002-9149(85)90882-3
  9. Sheehan FH, Mathey DG, Schofer J, Dodge HT, Bolson EL. Factors that determine recovery of left ventricular function after thrombolysis in patients with acute myocardial infarction. Circulation. 1985;71(6):1121-8. https://doi.org/10.1161/01.cir.71.6.1121
  10. Sikri N, Bardia A. A History of Streptokinase Use in Acute Myocardial Infarction. Tex Heart Inst J. 2007;34(3):318-27.
  11. Rezkalla SH, Stankowski RV, Hanna J, Kloner RA. Management of No-Reϐlow Phenomenon in the Catheterization Laboratory. JACC Cardiovasc Interv. 2017;10(3):215-23. https://doi.org/10.1016/j.jcin.2016.11.059. Erratum in: JACC Cardiovasc Interv. 2017;10(12):1282.
  12. Ibanez B, James S, Agewall S, Antunes MJ, Bucciarelli-DucciC, Bueno H, et al.; ESC Scientiϐic Document Group. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J. 2018;39(2):119-77. https://doi.org/10.1093/eurheartj/ehx393
  13. Fram DB, Aretz T, Azrin MA, Mitchel JF, Samady H, Gillam LD, et al. Localized intramural drug delivery during balloon angioplasty using hydrogel-coated balloons and pressure-augmented diffusion. J Am Coll Cardiol. 1994;23(7):1570-7. https://doi.org/10.1016/0735-1097(94)90658-0
  14. Niccoli G, Kharbanda RK, Crea F, Banning AP. No-reflow: Again prevention is better than treatment. Eur Heart J. 2010;31(20):2449-55. https://doi.org/10.1093/eurheartj/ehq299
  15. Mubagwa K, Mullane K, Flameng W. Role of adenosine in the heart and circulation. Cardiovasc Res. 1996;32(5):797-813. https://doi.org/10.1016/S0008-6363(96)00140-X
  16. Mehra A, Mohan B. Value of FFR in clinical practice. Indian Heart J. 2015;67(1):77-80. https://doi.org/10.1016/j.ihj.2015.02.025
  17. Ross AM, Gibbons RJ, Stone GW, Kloner RA, Alexander RW; AMISTAD-II Investigators. A Randomized, Double-Blinded, Placebo-Controlled Multicenter Trial of Adenosine as an Adjunct to Reperfusion in the Treatment of Acute Myocardial Infarction (AMISTAD-II). J Am Coll Cardiol. 2005;45(11):1775-80. https://doi.org/10.1016/j.jacc.2005.02.061
  18. Marzilli M, Orsini E, Marraccini P, Testa R. Beneϐicial Effects of Intracoronary Adenosine as an Adjunct to Primary Angioplasty in Acute Myocardial Infarction. Circulation. 2000;101(18):2154-9. https://doi.org/10.1161/01.cir.101.18.2154
  19. Hanna GP, Yhip P, Fujise K, Schroth GW, Rosales OR, Anderson HV, et al. Intracoronary adenosine administered during rotational atherectomy of complex lesions in native coronary arteries reduces the incidence of no-reϐlow phenomenon. Catheter Cardiovasc Interv. 1999;48(3):275-8. https://doi.org/10.1002/(SICI)1522-726X(199911)48:3<275::AID-CCD8>3.0.CO;2-M
  20. Gibson CM. Has My Patient Achieved Adequate Myocardial Reperfusion? Circulation. 2003;108(5):504-7. https://doi.org/10.1161/01.CIR.0000082932.69023.74
  21. Khan KA, Qamar N, Saghir T, Sial JA, Kumar D, Kumar R, et al. Comparison of Intracoronary Epinephrine and Adenosine for No-Reϐlow in Normotensive Patients With Acute Coronary Syndrome (COAR Trial). Circ Cardiovasc Interv. 2022;15(2):e011408. https://doi.org/10.1161/CIRCINTERVENTIONS.121.011408
  22. Baky SH, Singh BN. Verapamil Hydrochloride: Pharmacological Properties and Role in Cardiovascular Therapeutics. Pharmacotherapy. 1982;2(6):328-53. https://doi.org/10.1002/j.1875-9114.1982.tb03210.x
  23. Taniyama Y, Ito H, Iwakura K, Masuyama T, Hori M, Takiuchi S, et al. Beneϐicial Effect of Intracoronary Verapamil on Microvascular and Myocardial Salvage in Patients With Acute Myocardial Infarction. J Am Coll Cardiol. 1997;30(5):1193-9. https://doi.org/10.1016/S0735-1097(97)00277-5
  24. Taniyama Y, Ito H, Iwakura K, Masuyama T, Hori M, Takiuchi S, et al. Beneϐicial Effect of Intracoronary Verapamil on Microvascular and Myocardial Salvage in Patients With Acute Myocardial Infarction. J Am Coll Cardiol. 1997;30(5):1193-9. https://doi.org/10.1016/S0735-1097(97)00277-5
  25. Brown BG. Response of normal and diseased epicardial coronary arteries to vasoactive drugs: quantitative arteriographic studies. Am J Cardiol. 1985;56(9):23E-29E. https://doi.org/10.1016/0002-9149(85)91172-5
  26. Reyman HC. Diss. de vasis cordis propriis. Bibl Anat. 1737;2:359-79.
  27. Porstmann W, Iwig J. Die intramurale Koronarie im Angiogramm. Fortschr Geb Rontgenstr Nuklearmed. 1960;92(2):129-33. German. https://doi.org/10.1055/s-0029-1226492
  28. Ryan TJ. Revascularization: Reflections of a Clinician. J Am Coll Cardiol. 1998;31(4 Suppl B):89B-96B. https://doi.org/10.1016/S0735-1097(98)00020-5
  29. Jonassen AK, Mjos OD, Sack MN. p70s6 kinase is a functional target of insulin activated Akt cell-survival signaling. Biochem Biophys Res Commun. 2004;315(1):160-5. https://doi.org/10.1016/j.bbrc.2004.01.029
  30. Jonassen AK, Brar BK, Mjos OD, Sack MN, Latchman DS, Yellon DM. Insulin administered at reoxygenation exerts a cardioprotective effect in myocytes by a possible anti-apoptotic mechanism. J Mol Cell Cardiol. 2000;32(5):757-64. https://doi.org/10.1006/jmcc.2000.1118
  31. Jonassen AK, Sack MN, Mjos OD, Yellon DM. Myocardial Protection by Insulin at Reperfusion Requires EarlyAdministration and Is Mediated via Akt and p70s6 Kinase Cell-Survival Signaling. Circ Res. 2001;89(12):1191-8. https://doi.org/10.1161/hh2401.101385
  32. Helgeland E, Guvåg S, Jonassen AK. Insulin induced cytoprotection by mimicking postconditioning at myocardial reperfusion. J Mol Cell Cardiol. 2007;42(6):S185-S186. https://doi.org/10.1016/j.yjmcc.2007.03.567
  33. Slettom G, Jonassen AK, Tuseth V, Pettersen RJ, Larsen TH, Seifert R, et al. Percutaneous Catheter-based Intracoronary Infusion of Insulin – A Dose Finding Study in the Porcine Model. Basic Clin Pharmacol Toxicol. 2011;108(6):414-20. https://doi.org/10.1111/j.1742-7843.2011.00672.x
  34. Thuraisingham S, Tan KH. Dissolution of thrombus formed during direct coronary angioplasty with a single 10 mg intracoronary bolus dose of abciximab. Int J Clin Pract. 1999;53(8):604-7.
  35. Bartorelli AL, Trabattoni D, Galli S, Grancini L, Cozzi S, Ravagnani P. Successful dissolution of occlusive coronary thrombus with local administration of abciximab during PTCA. Catheter Cardiovasc Interv. 1999;48(2):211-3. https://doi.org/10.1002/(sici)1522-726x(199910)48:2<211::aid-ccd20>3.0.co;2-v
  36. Simon DI, Xu H, Ortlepp S, Rogers C, Rao NK. 7E3 MonoclonalAntibody Directed Against the Platelet Glycoprotein Iib/Iiia Cross-reacts With the Leukocyte Integrin Mac-1 and Blocks Adhesion to Fibrinogen and ICAM-1. Arterioscler Thromb Vasc Biol. 1997;17(3):528-35. https://doi.org/10.1161/01.atv.17.3.528
  37. Kintscher U, Kappert K, Schmidt G, Doerr G, Grill M, Wollert-Wulf B, et al. Effects of abciximab and tiroϐiban on vitronectin receptors in human endothelial and smooth muscle cells. Eur J Pharmacol. 2000;390(1-2):75-87. https://doi.org/10.1016/S0014-2999(99)00912-7
  38. Thiele H, Schindler K, Friedenberger J, Eitel I, Fürnau G, Grebe E, et al. Intracoronary Compared With Intravenous Bolus Abciximab Application in Patients With ST-Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention: The Randomized Leipzig Immediate Percutaneous Coronary Intervention Abciximab IV Versus IC in ST-Elevation Myocardial Infarction Trial. Circulation. 2008;118(1):49-57. https://doi.org/10.1161/CIRCULATIONAHA.107.747642
  39. Desch S, Siegemund A, Scholz U, Adam N, Eitel I, de Waha S,et al. Platelet inhibition and GP IIb/IIIa receptor occupancy by intracoronary versus intravenous bolus administration of abciximab in patients with ST-elevation myocardial infarction. Clin Res Cardiol. 2012;101(2):117-24. https://doi.org/10.1007/s00392-011-0372-6
  40. Jia H, Lu C, Sun P. Intracoronary administration of tiroϐiban during percutaneous coronary intervention facilitates patients with acute coronary syndrome. Oncotarget. 2017;8(63):107303-11. https://doi.org/10.18632/oncotarget.19179
  41. Zhao YJ, Fu XH, Ma XX, Wang DY, Dong QL, Wang YB, et al. Intracoronary ϐixed dose of nitroprusside via thrombus aspiration catheter for the prevention of the no-reflow phenomenon following primary percutaneous coronary intervention in acute myocardial infarction. Exp Ther Med. 2013;6(2):479-84. https://doi.org/10.3892/etm.2013.1139
  42. Leesar MA, Jneid H, Tang XL, Bolli R. Pretreatment With Intracoronary Enalaprilat Protects Human Myocardium During Percutaneous Coronary Angioplasty. J Am Coll Cardiol. 2007;49(15):1607-10. https://doi.org/10.1016/j.jacc.2007.01.060
  43. Zhang W, Dai J, Zheng X, Xu K, Yang X, Shen L, et al. Myocardial protective effect of intracoronary administration of nicorandil and alprostadil via targeted perfusion microcatheter in patients undergoing elective percutaneous coronary intervention: A randomized controlled trial. Medicine (Baltimore). 2021;100(15):e25551. https://doi.org/10.1097/MD.0000000000025551
Published
2022-12-26
How to Cite
Salo, S. V., Shumakov, V. O., Gavrylyshyn, A. Y., Levchyshyna, O. V., & Shpak, S. S. (2022). Intracoronary Administration of Drugs in Clinical Practice. Ukrainian Journal of Cardiovascular Surgery, 30(4), 12-19. https://doi.org/10.30702/ujcvs/22.30(04)/SS051-1219
Issue
Ukrainian Journal of Cardiovascular Surgery Vol 30 No 4 2022
Section
ISCHEMIC HEART DISEASE