Intracoronary focal nitroglycerin injection through drilled balloon is very effective in the resolution of coronary spasm versus into proximal coronary artery: A prospective randomized comparison study

Abstract

Background In this study, we aimed to compare the effectiveness and safety of NTG administration via catheter and local NTG infusion through a perforated balloon in order to prevent coronary spasm from developing during percutaneous intervention.

Method The study began with 1:1 randomization into two groups of a total of 1688 patients scheduled for PCT. A total of 91 patients in the proximal group who developed lesions received 500 mcg NTG through a catheter, while 85 patients in the local group with lesions developed during the procedure received 500 mcg local NTG through a perforated balloon. After excluding patients who did not develop lesions during the procedure, and those without any change in the lesion with NTG application, the study was completed with 74 patients in the local group, and 70 patients in the proximal group.

Results Both groups were similar in terms of basic characteristics. Incidences of procedure-related hypotension (10% vs 52%, P < 0.001) and tachycardia (20% vs 57%, P < 0.001) were significantly lower in the local NTG group. Success in addressing spasm was significantly higher in the local NTG than in the proximal NTG group (91.66 +/- 14.09% vs 75.99 +/- 16.86%, P < 0.001).

Discussion Intracoronary injection with a perforated balloon, a simple technique introduced worldwide with our publication, can be used for administration of local NTG. Using this method, NTG can be better delivered with the perforated balloon to the vascular epithelium because of lower output, higher eruption rate, and perpendicularity to the endothelium. In this application, the balloon can better deliver drugs to the desired area via back-and-forth movements using a 0.014 guidewire.

Conclusion The local administration of NTG to a spasming area through a perforated balloon is more effective and safer than the proximal administration of NTG.