Original Articles 27 6 1997 관상동맥스텐트시술전에실시한 국소 Nitric Oxide Donor 전달요법효과 Abstract 정명호 * 박종철 차광수 배열 안영근박주형 조정관 * 박종춘 * 강정채 * The Effects of Local Nitric Oxide Donor Delivery in Stented Patients Myung Ho Jeong, M.D.,* Jong Cheol Park, M.D., Kwang Soo Cha, M.D., Youl Bae, M.D., Young Keun Ahn, M.D., Joo Hyung Park, M.D., Jeong Gwan Cho, M.D.,* Jong Chun Park, M.D.,* Jung Chaee Kang, M.D.* Department of Internal Medicine, Chonnam University Medical School, The Research Institute of Medical Sciences of Chonnam National University,* Kwangju, Korea BackgroundThe 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 restenosis 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 OxideNO donor delivery on acute or subacute stent thrombosis and bleeding complications in patients, local NO donor delivery was performed in stented patients. MethodNO donor2.0mg, Molsidomine was delivered1.0ml/min over 10 min using the Dispatch Catheter, after predilation of target lesions in 15 patients8 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. ResultAll patients had no hypotensive effects, no ischemic symptoms or no ECG changes during and after local NO donor delivery. APTT 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 intrastent thrombus. No target lesion revascularization and 100 event free survival were observed for one month s clinical follow-up after local NO donor delivery and stenting. 592
ConclusionLocal NO donor delivery prior to stenting prevents acute and subacute stent thrombosis, systemic complications of nitrate, and maintains stent blood flow without stent recoil within the first one month after stenting. KEY WORDSLocal delivery Nitric oxide donor Acute and subacute stent thrombosis. 서 론 2. 방법 연구대상및방법 1. 연구대상 593
A A B B Fig. 1. A) The target lesion of left anterior descending artery was shown. B) Local delivery was performed using the Dispatch Catheter and distal blood flow was proved during local NO donor delivery. Fig. 2. A) Stent was placed immediately after local NO donor delivery at left anterior descending artery. B) Follow-up coronary angiogram was performed at 48 hours after local NO donor delivery and stenting. compliant PTCA balloon catheter를 표준형 inde- 결 flator를 이용하여 넓혔다(Fig. 2-A). 풍선과 관상동 과 맥의 직경 비율은 1.25 1로 하였다. NO donor를 국 소 전달요법을 실시한 후 Palmaz-Schatz coronary 1. 환자의 증상 및 심전도 변화 stents를 높은 압력을 주어 확장시켰다. 높은 압력은 모든 환자에서 국소 NO donor 전달 요법중이나 스 standard non-compliant PTCA balloons을 이용하여 텐트 시술후에 흉통 등은 없었으며, 동맥내에 삽입하 12 내지 16기압으로 실시하였다. 심전도, APTT(ac- 였던 sheath는 스텐트 시술 3시간 이내에 제거할 수 tivated partial thromboplastin time)과 CK(creatine 있었으며, 전 예에서 1개월간 스텐트 폐쇄를 의심할 만 kinase) 등은 국소 NO donor 전달 요법과 스텐트 시 한 증상이나 심전도 변화는 없었다. 술후 1, 3, 24시간에 측정하였다. 스텐트 시술후에 hep- 2. 국소 Nitric Oxide donor 전달 요법 arin이나 nitrate 등은 사용하지 않았다. 추적 관상동 표적 관상동맥 병변을 미리 확장시킨 후 국소 nitric 맥 조영술은 스텐트 시술 48시간후에 Phillips biplane oxide donor 전달 요법을 Dispatch Catheter를 통하 cineangiogram을 이용하여 실시하였고(Fig. 2-B), 정 여 실시하였다. 긴 300cm, 0.014 guide wire를 이 량적 분석은 Cardio 500(Kontron Inc.) program을 용하여 Dispatch Catheter를 표적 혈관에 위치시켰고 이용하여 실시하였다. 환자의 증상 관찰 및 심전도 등 2.0mg의 NO donor를 분당 1.0ml의 속도로 10분간 을 아급성 스텐트 혈전의 발생을 진단하기 위해 스텐 주입하였으며, 표적 혈관을 지나거나, Dispatch Cat- 트 시술 1개월간 실시하였다. heter의 spiral balloon을 확장시키고 10분간 국소에 594
3. 검사실소견 4. 추적정량적관상동맥조영소견 5. 추적임상관찰 고안 1. 급성혹은아급성스텐트혈전 Fig. 3. Activated partial thromboplastin timeaptt and creatine kinaseck at one, 3 and 24 hrs after local heaprin delivery and stenting. Fig. 4. Diameter stenosis measured by quantitative coronary angiogram, before predilation, after predilation, after local NO donor delivery, immediately after stenting and at 48 hours after stenting. 595
2. 국소전달요법 3. 국소 Nitric Oxide 전달요법 4. Nitric Oxide Donor 5. 본연구의제한점 596
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