ANGIOSCOPIC EVALUATION OF SITE-SPECIFIC ADMINISTRATION OF REOPRO

Systemic administration of newer antiplatelet agents such as the GP II b/IIIa agent ReoPro (Centocor BV Leiden, The Netherlands) has been sho wn to decrease the early incidence of recurrent ischemia and recurrent myocardial infarction, The currently approved protocol for administra tion of ReoPro involves an initial weight adjusted bolus followed by a systemic infusion over the next 12 hr, The systemic administration is proposed as the only route of administration because it is stated tha t the drug must be exposed to circulating platelets, An alternative ap proach would be to deliver ReoPro locally and allow the platelets to d isaggregate only when in contact with the local arterial wall, The opt imal method of monitoring the efficacy of such a strategy is to visual ly assess the presence of platelet rich or red blood cell rich thrombu s using angioscopy. We report our initial experience in 12 patients wh o received local administration of ReoPro using currently approved cat heters for local administration of agents into coronary arteries who w ere evaluated before and after intervention using intracoronary angios copy. None of the patients received a subsequent 12-hr infusion, There was successful resolution of thrombus in 11 of 12 patients, Recurrent ischemia occurred in one patient without myocardial infarction. (C) 1 997 Wiley-Liss, Inc.