Treating acute "no-reflow" with intracoronary adenosine in 4 patients during percutaneous coronary intervention.

Abstract

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.

• Authors: Mervyn B Forman, Dongming Hou, Edwin K Jackson
• Journal: Texas Heart Institute journal (Tex Heart Inst J) Vol. 35 Issue 4 Pg. 439-46 ( 2008) ISSN: 1526-6702 [Electronic] United States
• PMID: 19156238 (Publication Type: Case Reports, Journal Article)

Chemical References

• Vasodilator Agents
• Adenosine

Topics

• Acute Disease
• Adenosine (administration & dosage, therapeutic use)
• Aged
• Angioplasty, Balloon, Coronary (adverse effects)
• Coronary Artery Disease (therapy)
• Coronary Circulation (drug effects)
• Coronary Vessels (drug effects)
• Graft Survival
• Hemodynamics (drug effects)
• Humans
• Male
• Middle Aged
• Perfusion
• Vasodilator Agents (administration & dosage, therapeutic use)