title: Treatment of no-reflow and impaired flow with the nitric oxide donor nitroprusside following percutaneous coronary interventions: initial human clinical experience.
abstract: OBJECTIVE
  The objective of this study was to test the hypothesis that the intracoronary administration of a direct donor of nitric oxide is a safe and effective method to treat impaired blood flow (no-reflow phenomenon) that occurs during percutaneous transluminal coronary interventions (PTCI).
  
  
  BACKGROUND
  The absence of blood flow or decreased blood flow in a coronary artery following PTCI despite the presence of a patent epicardial vessel or graft is designated "no-reflow" or "impaired flow." This alteration in blood flow is a serious complication of percutaneous revascularization strategies that results in an increased incidence of morbidity, myocardial infarction and mortality.
  
  
  METHODS
  Nineteen consecutive patients undergoing standard percutaneous revascularization procedures complicated by either no-reflow or impaired flow that received intracoronary nitroprusside treatment were studied. One patient had two procedures performed on two separate grafts on two successive days. Interventions were performed on either saphenous vein grafts or native vessels and utilized angioplasty, stent deployment or rotational atherectomy strategies. Following interventions that were associated with impaired flow, varying total doses (of nitroprusside 50 to 1,000 microg) were administered into the coronary artery or saphenous vein graft. The angiographic archives before and after intracoronary administration of nitroprusside were analyzed for TIMI grade flow and a frame count method was used to quantitate blood flow velocity.
  
  
  RESULTS
  Following a PTCI that resulted in either no-reflow or impaired flow, nitroprusside (median dose 200 microg) was found to lead to a highly significant and rapid improvement in both angiographic flow (p < 0.01 compared with pretreatment angiogram) and blood flow velocity (p < 0.01 compared with pretreatment angiogram). No significant hypotension or other adverse clinical events were associated with nitroprusside administration.
  
  
  CONCLUSIONS
  The direct nitric oxide donor nitroprusside is an effective, safe treatment of impaired blood flow and no-reflow associated with PTCI. The use of nitroprusside to treat syndromes secondary to microvascular dysfunction may provide a novel therapeutic strategy for treating no-reflow or impaired blood flow following percutaneous interventions.
authors: Division of Cardiology, University of Alabama, Birmingham, USA.
authors: W B
authors: WB
authors: Hillegass
authors: N A
authors: NA
authors: Dean
authors: L
authors: L
authors: Liao
authors: R G
authors: RG
authors: Rhinehart
authors: P R
authors: PR
authors: Myers
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D017023:Coronary Angiography; D001026:Coronary Artery Bypass; D003326:Coronary Circulation / Q000187:drug effects* / Q000502:physiology; D003327:Coronary Disease / Q000503:physiopathology / Q000628:therapy*; D004305:Dose-Response Relationship, Drug; D005260:Female; D006083:Graft Occlusion, Vascular / Q000628:therapy; D006801:Humans; D007261:Infusions, Intra-Arterial; D008297:Male; D008833:Microcirculation / Q000187:drug effects / Q000503:physiopathology; D008875:Middle Aged; D009569:Nitric Oxide / Q000502:physiology*; D009599:Nitroprusside / Q000008:administration & dosage* / Q000009:adverse effects; D012189:Retrospective Studies; D016896:Treatment Outcome; D014680:Veins / Q000637:transplantation
chemical_list: D009599:Nitroprusside; D009569:Nitric Oxide