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Nitric Oxide Donor Curbs Asymptomatic Embolisation After Carotid Angioplasty
A DGReview of :"S-nitrosoglutathione reduces asymptomatic embolization after carotid angioplasty."
Circulation
12/24/2002
By Anne MacLennan
The nitric oxide donor S-nitrosoglutathione (GSNO) rapidly curbs frequency of embolic signals after endovascular treatment for symptomatic high-grade carotid stenosis.
This is the finding of researchers in England following an evaluation of the effectiveness of GSNO in reducing embolisation after carotid angioplasty.
Embolic stroke is the major complication of carotid angioplasty and may occur after balloon inflation and deflation or in the early postintervention period.
In early post-angioplasty embolisation and stroke, a key role appears to be played by platelet adhesion and aggregation to the angioplasty site, with subsequent embolisation.
During this period, despite aspirin and heparin treatment, asymptomatic embolic signals can be detected in patients by transcranial Doppler ultrasound.
Dr Z Kaposzta and colleagues from the Clinical Neuroscience, St George's Hospital Medical School, London, examined the effect of GSNO because this nitric oxide donor appears to have relative platelet specificity.
Study participants were 16 patients undergoing carotid angioplasty and stenting for symptomatic 70 percent or more internal carotid artery stenosis.
They were randomly assigned in a double-blind manner to either GSNO or to placebo given after surgery for 90 minutes. All patients were also pre-treated with aspirin and given heparin for 24 after the procedure.
For one hour before treatment and at zero to three, six and 24 hours after treatment, researchers did transcranial Doppler recordings from the ipsilateral middle cerebral artery.
The GSNO treatment resulted in a rapid reduction in frequency of embolic signals of 95 percent at zero to three hours and 100 percent at six (P=0.007 and P=0.01 versus placebo, respectively).
Although two patients in the placebo group experienced ipsilateral stroke after the angioplasty, no cerebrovascular events occurred in the patients on GSNO treatment.
Circulation 2002;106(24):3057-62.
"S-nitrosoglutathione reduces asymptomatic embolization after carotid angioplasty."
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