The Effects of Local Nitric Oxide Donor Delivery in Stented Patients

Jeong, Myung Ho; Park, Jong Cheol; Cha, Kwang Soo; Bae, Youl; Ahn, Young Keun; Park, Joo Hyung; Cho, Jeong Gwan; Park, Jong Chun; Kang, Jung Chaee

Abstract

BACKGROUND
The endovascular stent has been applied clinically in acute arterial occlusions after intimal dissection by angioplasty and in the prevention of restenosis. However, subacute stent thrombosis and restnosis remain major concerns in clinical stenting despite intravscular ultrasound guidance and high pressure inflation. Moreover, anticoagulation before and after stent implantation may be required for long periods and complicated by bleeding. A new strategy may be local drug delivery, which maintains sustained local concentration and may limit systemic complications. To evaluate the efficacy of local Nitric Oxide(NO) donor delivery on acute or subacute stent thrombosis and bleeding complications in patients, local NO donor delivery was performed in stented patients. METHOD: NO donor (2.0mg, Molsidomine) was delivered (1.0ml/min over 10min) using the Dispatch Catheter, after predilation of target lesion in 15 patients (8 angina, 7 myocardial infarction, mean age 5311.5 yr.) without heparin or nitrate infusion after stenting. After local NO donor delivery, Palmaz-Schatz stents were placed with standard methods. APTT and CK were checked at 1 hr, 3 hrs and 24 hrs after local NO donor delivery and STENTING. Follow-up coronary angiograms were done 48 hrs after stenting. RESULT: All patients had no hypotensive effects, no ischemic symptoms or no ECG changes during and after locaL NO donor delivery. ARTT and CK values were not changed at 3 and 24 hrs after local NO donor delivery and stenting. This allowed early arterial sheath removal. Follow-up coronary angiograms at 48 hrs showed all stents patent without stent recoil, with TIMI III flow, and without intra-stent thrombus. No target lesion revascularization and 100% event free survival were obsered for one month's clinical follow-up after NO donor delivery and stenting.
Conclusion
Local NO donor delivery prior to stenting prevents acute and subacute stent thrombosis, systmic complications of nitrate, and maintains stent blood flow without stent recoil within the first one month after stenting.