TEMPORARY REMOVAL: Refractory Coronary No-Reflow Reversed by Prolonged Intracoronary Nitroprusside Via an Innovative...

Area of Science:

• Cardiology
• Interventional Cardiology
• Vascular Medicine

Background:

• Refractory coronary no-reflow (CNR) lacks effective localized management strategies when standard treatments fail.
• Delayed presentation of ST-segment elevation myocardial infarction poses treatment challenges.

Purpose of the Study:

• To evaluate a novel localized, prolonged sodium nitroprusside infusion strategy for refractory coronary no-reflow.
• To assess the safety and efficacy of this approach in patients with delayed myocardial infarction presentation.

Main Methods:

• Two patients with refractory CNR (TIMI flow grade 0-1) after rescue percutaneous coronary intervention received prolonged (8-12 hours) bedside infusion of sodium nitroprusside (8 μg/min) via an arterial infusion microcatheter.
• Conventional therapies including thrombectomy and vasodilator boluses had previously failed.

Main Results:

• The localized sodium nitroprusside infusion successfully reversed microvascular obstruction.
• Complete restoration of TIMI flow grade 3 was achieved, along with resolution of atrioventricular block.
• Significant preservation of ventricular function was observed.

Conclusions:

• Prolonged, localized sodium nitroprusside delivery via microcatheter is an effective bailout strategy for refractory coronary no-reflow.
• This approach can salvage hibernating myocardium beyond the typical reperfusion window.
• It offers a novel method to restore blood flow in complex coronary interventions.