Reducing Infarct Size and improving Cardiac Function after Acute Myocardial Infarction (AMI)
PiCSO Therapy aims to improve myocardial perfusion and cardiac function in patients with myocardial infarction by redistributing blood flow into the damaged area during PCI.
Pre-clinical and clinical studies demonstrated that PiCSO, in addition to standard PCI, may significantly reduce the infarct size after acute myocardial infarction. Infarct size has shown to be strongly predictive of subsequent all-cause mortality and rehospitalization for heart failure after primary PCI.
Figure 1: Pressure-controlled intermittent Coronary Sinus Occlusion (PiCSO) reduces infarct size after primary PCI: A propensity – controlled matched study
PiCSO during Percutaneous Coronary Intervention (PCI)
PiCSO Therapy is applied immediately following flow restoration and during coronary artery stenting in patients presenting with acute myocardial infarction. The therapy is automatically adapted to the patient’s individual anatomy and hemodynamics and extends average cath lab time by only 20-30 minutes.
The PiCSO Impulse System consists of a balloon tipped catheter and a driving console. The PiCSO Impulse Catheter is inserted in a standard manner via the femoral vein and placed in the coronary sinus using a steerable guide sheath (Figure 2). Intermittent coronary sinus occlusion is controlled by the PiCSO Impulse Console using the unique, proprietary ‘Wien Algorithm’ which continuously monitors coronary sinus pressure dynamics and automatically sets the time of occlusion and release phases based on venous pressure.
Figure 2: PiCSO Impulse Catheter Placement in the Coronary Sinus
Unique Modes of Action
The PiCSO principle is based on the fact that coronary sinus pressure will increase when the vessel is occluded and drainage of venous blood into the right atrium is inhibited. During occlusion, pressure will rise from normal right atrial pressure to a pressure plateau, without effecting arterial systemic pressure (Figure 3). This pressure build-up translates into an increase in (arterial) wedge pressure over the ischemic area.
Figure 3: Coronary Sinus Pressure Increase during PiCSO
Clinical and pre-clinical studies have shown that the effectiveness of PiCSO Therapy is based on three main modes of action. The intermittent coronary sinus pressure increase leads to:
- Redistribution of blood to the border zone of the deprived myocardium2
- Enhanced washout of deleterious agents from the microcirculation3
- Increased expression of vascular endothelial growth factor in the myocardium4,5
It could be shown that myocardial salvage is related to increase in coronary artery pressure and coronary sinus pressure amplitude.6
Figure 4 shows a schematic view of the main modes of action of PiCSO: The redistribution of blood and the washout of deleterious agents.
Figure 4: Improved Microvascular Reperfusion
-  Egred M.: A propensity – controlled matched study
-  Beatt KJ, et al., Br Heart J 1988;59:159-67
-  Weigel G, et al., J Thorac Surg 2007;133
-  Mohl W, et al., Nat Clin Pract Cardiovasc Med 2008;5:528-0
-  Mohl W, et al., Am J Cardiol 1984 Mar 15;53(7):923-8