Treating acute "no-reflow" with intracoronary adenosine in 4 patients during percutaneous coronary intervention.
Angiographic evidence of impaired tissue perfusion, known as the "no-reflow" phenomenon, is a serious complication of percutaneous coronary intervention-one that is associated with increased mortality rates. Adenosine is an endogenous nucleoside that attenuates many of the mechanisms that are responsible for no-reflow. Herein, we report the cases of 4 patients who developed the no-reflow phenomenon after elective percutaneous coronary intervention to their native coronary arteries and saphenous vein grafts. In all 4 patients, and without adverse effects, small bolus doses of adenosine through the guiding catheter improved epicardial perfusion--measured by either Thrombolysis In Myocardial Infarction (TIMI) flow grade or corrected TIMI frame count-and tissue-level perfusion, graded according to myocardial blush. In view of adenosine's extremely short half-life in blood, the continuous administration of adenosine into the distal vascular bed throughout percutaneous coronary intervention may further improve outcomes by reversing or preventing the no-reflow phenomenon.
Forman
Mervyn B
MB
Saint Joseph's Translational Research Institute, Saint Joseph's Hospital, Atlanta, Georgia 30342, USA.
Hou
Dongming
D
Jackson
Edwin K
EK
D000208:Acute Disease; D000241:Adenosine / Q000008:administration & dosage / Q000627:therapeutic use*; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects*; D003324:Coronary Artery Disease / Q000628:therapy*; D003326:Coronary Circulation / Q000187:drug effects*; D003331:Coronary Vessels / Q000187:drug effects; D006085:Graft Survival; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D010477:Perfusion; D014665:Vasodilator Agents / Q000008:administration & dosage / Q000627:therapeutic use*
D014665:Vasodilator Agents; D000241:Adenosine