title: Efficacy and Safety of Local Intracoronary Drug Delivery in Treatment of No-Reflow Phenomenon: A Pilot Study.
abstract: BACKGROUND
  Successful reopening of epicardial coronary artery does not always mean optimal myocardial reperfusion in a sizable portion of patients, mostly because of no-reflow phenomenon.
  
  
  OBJECTIVE
  We investigated whether local injection of adrenaline ± verapamil in the distal coronary bed is more effective than their intracoronary (IC) injection through the guiding catheter in the treatment of no-reflow phenomenon following percutaneous coronary intervention (PCI).
  
  
  METHODS
  A total of 40 patients with no-reflow following PCI were randomized into two groups. Group 1 received IC adrenaline ± verapamil through a well-cannulated guiding catheter while Group 2 received the above-mentioned drugs in the distal coronary bed through a perfusion balloon or selective microcatheter. The primary end points were the achievement of TIMI III flow with MBG II or III. Secondary end points were the occurrence of hypotension, arrhythmias, and major adverse cardiac events (MACEs) during hospital stay.
  
  
  RESULTS
  After drug injection, the percentage of patients achieving Thrombolysis in Myocardial Infarction (TIMI) III flow in Group 1 was 40% versus 80% in Group 2, P = 0.032. MBG II and III was significantly lower in Group 1; 10% and 25% versus 15% and 65% in Group 2, respectively, P = 0.033. Primary end points were achieved in only 35% of patients in Group 1 and in 80% of patients in Group 2 (odds ratio, 7.43, 95% confidence interval 1.78-31.04, P < 0.01). Secondary end points were not different between both groups.
  
  
  CONCLUSIONS
  Local intra-coronary delivery of adrenaline ± verapamil is a safe and effective method for the treatment of no-reflow phenomenon complicating PCI.
authors.affiliation: Department of Cardiology, Ain Shams University Hospitals, Cairo, Egypt. tamerabuarab1@yahoo.com.
authors.forename: Tamer
authors.initials: T
authors.lastname: Abu Arab
authors.affiliation: Department of Cardiology, Ain Shams University Hospitals, Cairo, Egypt.
authors.forename: Ramy
authors.initials: R
authors.lastname: Rafik
authors.affiliation: Department of Cardiology, Ain Shams University Hospitals, Cairo, Egypt.
authors.forename: Adel
authors.initials: A
authors.lastname: El Etriby
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000379:methods; D002317:Cardiovascular Agents / Q000008:administration & dosage; D017023:Coronary Angiography / Q000379:methods; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000187:drug effects; D004837:Epinephrine / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D007269:Injections, Intra-Arterial / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015425:Myocardial Reperfusion / Q000379:methods; D054318:No-Reflow Phenomenon / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D010865:Pilot Projects; D016896:Treatment Outcome; D014700:Verapamil / Q000008:administration & dosage*
chemical_list: D002317:Cardiovascular Agents; D014700:Verapamil; D004837:Epinephrine