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

Mervyn B Forman1, Dongming Hou, Edwin K Jackson

  • 1Saint Joseph's Translational Research Institute, Saint Joseph's Hospital, Atlanta, Georgia 30342, USA.

Texas Heart Institute Journal
|January 22, 2009
PubMed

Insights

Adenosine effectively improved blood flow and tissue perfusion in patients experiencing the no-reflow phenomenon after percutaneous coronary intervention. Continuous adenosine administration may further enhance outcomes by preventing this complication.

Area of Science:

  • Cardiology
  • Pharmacology

Background:

  • The no-reflow phenomenon, characterized by impaired tissue perfusion, is a significant complication of percutaneous coronary intervention (PCI).
  • This phenomenon is linked to increased mortality rates and poses a challenge in cardiovascular interventions.

Observation:

  • Four patients undergoing elective PCI developed the no-reflow phenomenon in native coronary arteries and saphenous vein grafts.
  • Adenosine, an endogenous nucleoside, was administered in small bolus doses via the guiding catheter.

Findings:

  • Adenosine administration resulted in improved epicardial perfusion, assessed by Thrombolysis In Myocardial Infarction (TIMI) flow grade and corrected TIMI frame count.
  • Tissue-level perfusion, evaluated by myocardial blush, also showed improvement following adenosine treatment.
  • No adverse effects were reported during adenosine administration.

Implications:

  • Adenosine demonstrates potential in reversing and mitigating the no-reflow phenomenon post-PCI.
  • Continuous adenosine administration during PCI may offer improved outcomes by preventing or reversing impaired tissue perfusion.
  • Further research into continuous adenosine infusion protocols is warranted to optimize its therapeutic role in PCI.

Keywords:
Adenosine/administration & dosage/physiology/therapeutic useangioplasty, transluminal, percutaneous coronary/adverse effects/methodsatherosclerosis/complications/therapycardiotonic agents/administration & dosage/therapeutic usecoronary vessels/drug effectscreatine kinase/blooddose-response relationship, druggraft occlusion, vascular/therapymyocardial reperfusion/methodstreatment outcomevasodilator agents/administration & dosage/therapeutic use

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