Pressure-controlled intermittent coronary sinus occlusion (PICSO)
Medikoe Health Expert
Koramangala, bengaluru, karnataka, india, Bengaluru Feb 9, 2017
Pressure-controlled Intermittent Coronary Sinus Occlusion (also known as PICSO), is a procedure utilized to enhance restoration of blood flow to the microcirculation in heart tissue following a myocardial infarction. PICSO has a dual therapeutic potential first for myocardial salvage and second for tissue regeneration. In a meta-analysis of preclinical studies a significant reduction of infarct size of about 30% as compared to controls was observed. Pilot clinical studies of PICSO in acute myocardial infarction confirmed an event free survival of patients indicating a significant risk reduction for reinfarction.
Myocardial infarction (MI), or heart attack, occurs when a blood clot forms around a plaque already obstructing flow in coronary arteries preventing proper blood supply. Total occlusion of a coronary artery is the consequence of a plaque rupture and forming a blood clot disrupting blood flow. This leads to a risk zone with rapid loss of oxygen delivery, deprivation of nutritive flow to the heart leading to necrosis of the myocardium known as MI. Myocardial infarctions are graded according to severity: The less severe type is Non ST-segment Elevated Myocardial infarction (NSTEMI) with deprivation of flow occurring only in the subendocardium. ST-Segment Elevation Myocardial Infarction (STEMI) is the severe type.
The origin of coronary sinus intervention
The coronary sinus collects about 70% of the myocardial outflow. There are early concepts using the coronary sinus to access ischemic myocardium. First clinically useful techniques go back to the 1940s. In early experimental studies the consequences of elevated pressure in cardiac veins have been analyzed. The Beck´s procedure was an operation in patients with severe coronary artery disease long before modern cardiac surgery could be performed.