Successful coronary stent implantation using local nitric oxide donor delivery

With the introduction of high pressure balloon inflations and antiplatelet therapy, the incidence of stent thrombosis has been markedly reduced, bur t he incidence of late stent restenosis has not. A new strategy may be focal drug delivery, which maintains sustained local concentration and limits sys temic complications. To evaluate the efficacy of local nitric oxide (NO) do nor delivery on stent thrombosis and complications, local NO donor delivery was performed in stented patients. NO donor (2.0-mg molsidomine) was deliv ered (1.0 mL/min > 10 min) using the Dispatch Catheter after predilation of target lesions in 13 patients (6 angina 7 myocardial infarction, age 53.1 +/- 11.4 years). After local NO donor delivery, Palmaz-Schatz stents were p laced using standard methods. Follow-up coronary angiograms were performed 48 hours and 6 months after stenting. None of the patients had hypotensive effects ischemic symptoms, or ECG changes during and after local NO donor d elivery. APTT and CK values were unchanged at 3 and 24 hours after local NO donor delivery and stenting. Follow-up coronary angiograms at 48 hours and 6 months showed all stents patent with TIMI III flow and without intrasten t thrombus. No target lesion revascularization and 100% event-free survival were observed during the 6-month clinical follow-up period. Intracoronary stenting may be performed safely and effectively by local NO donor delivery prior to stent implantation.