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Reperfusion Microvascular Ischemia After Prolonged Coronary Occlusion: Implications And Treatment With Local Supersaturated Oxygen Delivery

Authors Spears JR

Received 31 May 2019

Accepted for publication 20 September 2019

Published 21 October 2019 Volume 2019:7 Pages 65—79


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 3

Editor who approved publication: Prof. Dr. Dörthe Katschinski

James Richard Spears

Cardiovascular Research Laboratory, Department of Medicine, Division of Cardiology, Beaumont Heart & Vascular Center, Dearborn, MI 48124, USA

Correspondence: James Richard Spears
Cardiovascular Research Laboratory, Department of Medicine, Division of Cardiology, Beaumont Heart & Vascular Center, 22060 Beech St, Suite 200, Dearborn, MI 48124, USA
Tel +1 313-228-0505
Fax +1 313-228-0508

Abstract: Following a prolonged coronary arterial occlusion, heterogeneously scattered, focal regions of low erythrocyte flow are commonly found throughout the reperfused myocardium. Experimental studies have also demonstrated the presence of widespread, focally patchy regions of microvascular ischemia during reperfusion (RMI). However, the potential contribution of RMI to tissue viability and function has received little attention in the absence of practical clinical methods for its detection. In this review, the anatomic/functional basis of RMI is summarized, along with the evidence for its presence in reperfused myocardium. Advances in microcirculation research related to obstructive responses of vascular endothelial cells and blood elements to the effects of hypoxia and low shear stress are discussed, and a potential cycle of intensification of RMI from such responses and progressive loss of functional capillary density is presented. In capillaries with impaired erythrocyte flow, compensatory increases in the delivery of oxygen, because of its low solubility in plasma, are effective only at high partial pressures. As discussed herein, attenuation of the cycle with oxygen at hyperbaric levels in plasma is, very likely, responsible for improved tissue level perfusion noted experimentally. Observed clinical benefits from intracoronary SuperSaturated oxygen (SSO2) delivery, including infarct size reduction, can be attributed to attenuation of RMI with improvement in microvascular blood flow.

Keywords: oxygen, ischemia, capillaries, reperfusion, plasma

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