Researchers in the Cardiac Catheterization Laboratory at Thomas Jefferson University have found that nicardipine, a commonly available calcium channel blocker, is effective in reversing the ‘no-reflow’ phenomenon that affects as many as 50,000 patients annually who undergo angioplasty—a procedure to clear arteries that have been clogged up or narrowed by plaque.
‘No reflow’ is a condition in which even after a successful angioplasty, where it appears that the obstruction in the heart vessel has been eliminated and the vessel is opened, there is no blood flow to the heart muscle. “It is likened to a clogged drain,” said
Michael Savage, M.D., Catheterization Laboratory director, “and happens more frequently in veins that have been taken from the leg and used in heart bypass.”
Sometimes as a result of the angioplasty, plaque that has been dislodged releases chemical agents that affect the small blood vessels in the artery causing spasm and a lack of blood flow to the heart.
“No-reflow can be a potentially serious complication that places patients at high risk of heart attack or even death,” explains Dr. Savage.
In a study to be published in the November issue of Catheterization and Cardiovascular Interventions, the Thomas Jefferson University heart researchers set out to look at the efficacy and safety of nicardipine reversing of no-reflow. They looked retrospectively at 1,454 patients who were treated in the Lab. Of this group, 72 developed no-reflow and were treated with the nicardipine to reverse the condition.
Seventy one (98 percent) of these patients were treated successfully and the no-reflow problem was reversed. The researchers report that nicardipine therapy was well tolerated. No patient experienced low blood pressure (hypotension), heart block or required a temporary pacemaker.
“In this largest series to date, intracoronary nicardipine was demonstrated to be a safe and highly effective pharmacological agent to reverse no-reflow during angioplasty,” said
Dr. Savage, who is also associate professor of Medicine at Jefferson Medical College of Thomas Jefferson University.
Additional members of the Jefferson University team who conducted this study are:
Raymond I. Huang, M.D., Parul Patel, M.D., Paul Walinsky, M.D., David L. Fischman, M.D., David Ogilby, M.D., Mark Awar, M.D. and Craig Frankil, D.O.
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