Efficacy and Safety of Distal Intracoronary Drug Delivery in Treatment of No-Reflow Phenomenon

Abstract

A ngiographic no-reflow is defined as less than TIMI 3 flow or TIMI 3 flow with MBG 0 or 1 without angiographic evidence of mechanical vessel obstruction. [3, 24] No-reflow occurs in >30% of patients after thrombolysis or mechanical intervention for acute myocardial infarction and in 0•6% to 2% of elective PCI. [25] Persistent no-reflow has been associated with increased mortality and a high incidence congestive heart failure. [25] The pathophysiology of no-reflow encompasses four interacting mechanisms; ischemic injury, reperfusion injury, distal embolization and individual susceptibility. [28] Prevention and treatment of no-reflow are very important to improve cardiovascular outcomes. Intracoronary route of drug delivery is used in the treatment of no-reflow. Drugs can be injected through the guiding catheter or through a microcatheter or Clearway balloon in the distal coronary bed. In our study we compared the route of drug delivery in the treatment of no-reflow. In the current study we randomized 40 patients presenting with no-reflow after PCI into two groups. Group 1 (20 patients) was treated by injecting epinephrine and verapamil through the guiding catheter, group 2 (20 patients) was treated by distal drug delivery. Repeated injections were done at the discretion of the operator till best flow is achieved.