Interventions innovatrices complémentaires à l'angioplastie primaire afin de réduire le phénomène de no-reflow lors du traitement de l'infarctus aigu du myocarde.

Chercheurs-boursiers cliniciens - Junior 1 | Concours 2012-2013


Thierry Charron

Centre de recherche de l'Hôpital du Sacré-Coeur de Montréal

 

Domaine : Santé circulatoire et respiratoire

The abrupt closure of a coronary artery (artery on the heart) by a blood clot remains the most dramatic way of presentation of a heart attack (myocardial infarction). Dilation of the occluded artery with a balloon (primary angioplasty) remains the preferred way to treat heart attack. However, in 20% of patients treated for heart attack with primary angioplasty, the blood flow in the artery will be reduced even if the artery is wide open. The medical condition to describe this phenomenon is No-Reflow. If the blood flow is reduced in the artery, the blood flow will also be reduced into the cardiac muscle which decreases the chance of good healing. In patients whom present with No-Reflow at the end of primary angioplasty, the chance of dying during the time they stay at the hospital is 12%. The main cause to explain the No-Reflow is the obstruction of a small blood vessel in the cardiac muscle. These small blood vessels are blocked by dammage done by the heart attack itself but also by dammage induced by the reestablishment of fresh blood in the previously occluded artery (reperfusion injury). A novel approach of treatment, which promotes cardiac muscle protection during reperfusion, seems to be the future. Tumor necrosis factor-alpha (TNF) has been shown to be able to protect the cardiac muscle from No-Reflow. Moreover, local delivery of a cardioprotective medication at the site of myocardial infarction with a special catheter specifically designs for it makes more sense than intravenous infusion of a medication through all the body. The objectives of this research program will be to assess the therapeutic potential of TNF to reduce the No-Reflow phenomenon and to develop a new catheter for local infusion of a cardioprotective drug in the myocardial infarction area.