Angioplasty complications

Tcheng JE, Kandzari DE, Grines CL, Cox DA, Effron MB, Garcia E et al. Benefits and risks of abciximab use in primary angioplasty for acute myocardial infarction the Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications (CADILLAC) trial. Circulation 2003 108(ll) 1316-23. 

Monoclonal antibodies (MAb) or MAb fragments have been described above as homing devices for soluble and participate carriers however, they can also be used in their own right as soluble carriers. The first marketed (1986) MAb for therapeutic use was the anti-CD3 antibody OKT3, for the prevention of rejection of kidney transplants. More recently, MAb for the treatment of post angioplasty complications (ReoPro) and for the treatment of colorectal cancers (Panorex) have been introduced. 

Patients undergoing PCIs to revascularize arteries are also subject to arterial injury, new plaque rupture, and thrombus formation. Gpllb/llla inhibitors are used in conjunction with heparin and aspirin to treat patients with ACS that will undergo PCI. Gpllb/llla inhibitors have been shown to reduce mortality, reinfarction, and revascularization in this patient population. The use of Gpllb/llla inhibitors decreases the ischemic events and angioplasty complications and improves outcomes of coronary stenting. 

A recent review article listed the current indications for peripheral, noncoronary vascular stent placement (Mattos et al., 1999). The reported indications include immediate treatment of balloon angioplasty complications such as intimal dissection and flap formation the correction of unsatisfactory angioplasty outcomes such as residual stenosis, spasm, recoil or occlusion treatment of complicated, chronic lesions or occlusions and as a routine combination treatment with angioplasty. The most common reason for placement of a stent in the peripheral vasculature is an unsatisfactory result from angioplasty. 

GPIIb/IIIa antagonists have to be administered parenterally. They are currently used prophylactically during intracoronary interventions such as percutaneous transluminal revascularization with balloon angioplasty or intracoronary stenting, as well as to treat acute coronary syndromes like unstable angina and acute myocardial infarction. The main complications... 

Buffon A, Liuzzo G, Biasucci LM, et al. Preprocedural serum levels of C-reactive protein predict early complications and late restenosis after coronary angioplasty. J Am Coll Cardiol 1999 34 1512-1521. 

Mark DB, Talley JD, Topol EJ, Bowman L, Lam LC, Anderson KM et al. Economic assessment of platelet glycoprotein Ilb/IIIa inhibition for prevention of ischemic complications of high-risk coronary angioplasty. EPIC Investigators. Circulation 1996 94 629-35. 

Indications Prevention of ischemic complications in unstable angina patients during coronary angioplasty... 

B. Indications and use Angiomax is indicated when given with aspirin for the prevention of ischemic complications in unstable angina patients during coronary angioplasty. It has been used successfully as a substitute for heparin. The efficacy of Angiomax appears to be similar to heparin with fewer bleeding complications. 

ReoPro (Abciximab) Glycoprotein Ilb/IIIa receptor Chimeric Fab Complication of coronary angioplasty 1994... 

White C, Chaitman B, Knudtson M, Chisholm R. Antiplatelet agents are effective in reducing the acute ischemic complications of angioplasty but do not prevent restenosis results from the ticlopidine trial. Coron Artery Dis 1991 2 757-767. 

In 1997, Condado et al. was the first to investigate the effectiveness of ICB after PTCA in human coronary arteries. Twenty-one patients who underwent PTCA for unstable angina received ICB (gamma radiation) for prevention of restenosis, Immediate and six-month follow-up revealed improved freedom from major adverse cardiac event (MACE) defined as death, myocardial infarction or target lesion revascularization compared with several previously completed balloon angioplasty trials (20), More importantly, this trial demonstrated that ICB was a feasible technique for the prevention of restenosis without any unexpected acute complications in humans. 

Barnathan ES, Schwartz JS, Taylor L, et al. Aspirin and dipyridamole in the prevention of acute coronary thrombosis complicating coronary angioplasty. Circulation 1987 76(1) 125-134. 

Lembo NJ, Black AJ, Roubin GS, et al. Effect of pretreatment with aspirin versus aspirin plus dipyridamole on frequency and type of acute complications of percutaneous transluminal coronary angioplasty. Am J Cardiol 1990 65(7) 422-426. 

The active substance in bivalirudin (Hirulog), a direct thrombin inhibitor, is a 20-amino acids ynthetic peptide based on the hirudin template. In the Hirulog angioplasty study, 4098 patients with unstable or post infarction angina were randomized to bivalirudin or heparin before PTCA (14). The conclusion of this study was that there was no difference in the 30-day primary endpoint with either treatment. Patients randomized to Hirulog, however, did have a statistically significant reduced incidence of bleeding-related complications. 

As yet there are no completed megatrials with the newer statins. A study that compared atorvastatin versus angioplasty in 341 patients with stable CHD over 18 months was recently reported (Pitt et al., 1999). There were fewer ischemic events in the atorvastatin group, but the difference did not quite reach statistical significance. Furthermore, a previous study had shown a significantly lower incidence of such events in a group treated with conventional medical therapy, because angioplasty can be complicated by myocardial infarction and other acute coronary events (RITA-2 trial participants, 1997). 

Effects of glycoprotein llb/llla receptor antagonists on the incidence of death or nonfatal myocardial infarction following percutaneous transluminal coronary angioplasty. [ Note Data are from several studies thus reported incidence of complications with standard therapy is not the same for each drug.]... 

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