Pressure-controlled intermittent coronary sinus occlusion impulse system
The Pressure-controlled Intermittent Coronary Sinus Occlusion Impulse System (also known as PISCO Impulse System which is a registered trademark), is a procedure utilized to enhance restoration of blood flow to the microcirculation in the heart tissue following a myocardial infarction.
History
A myocardial infarction, or heart attack, is typically due to the build-up of plaque along the coronary arteries of the heart, causing them to narrow and PReVENT proper blood supply. A plaque may break off and form blood clots that disrupt blood flow and inhibit oxygen delivery to the heart leading to a MI. A lack of oxygen and nutrient supply along with a reduction in waste removal in tissue damage that may lead to cell death and myocardial dysfunction.
Coronary angioplasty has been used as a way to restore blood flow following an MI to the heart in order to prevent excessive damage to the tissue. Despite the restoration of blood flow that occurs with this procedure, approximately 30-40% of patients still have poor health outcomes. This is most likely the result of inadequate blood flow to the smaller arteries and veins of the heart which play a vital role in the delivery of blood and nutrients to the heart muscle. Reduced blood flow causes scar tissue to develop within regions of the heart leading to reduced heart function and the potential for heart failure to develop.,.
Overview
The Impulse System functions by alternatively increasing and decreasing pressure in the coronary venous system to improve perfusion (blood flow) and reduce the risk of further complications. A balloon mounted catheter is inserted into the femoral vein along with a guide wire, and the catheter is fed into the coronary sinus. The coronary sinus is The Primary vein of the heart and is responsible for collecting deoxygenated blood from a series of veins and delivering it to the right atrium. Once inside the coronary sinus, a console is responsible for orchestrating an inflation and deflation cycle of the balloon on the catheter. This cycle is correlated to the pressure that occurs in the coronary sinus when it is blocked. When the balloon is inflated, it temporarily blocks the venous outflow from the heart which increases venous coronary pressure, ultimately leading to the redistribution of blood flow into the affected heart tissue. Eventually, the coronary sinus pressure reaches a plateau when the catheter balloon can then be deflated, causing a washout of the venous circulation removing any cellular debris that May Be present.
By temporarily increasing the pressure within the coronary sinus blood is redirected to areas of the heart that previously had limited blood flow. This permits adequate perfusion, oxygen supply, and removal of waste products. The system improves outcomes for heart attack patients by altering the pressure and blood flow within the venous microcirculation ultimately preventing death of the heart tissue,.