The Use of Intracoronary Sodium Nitroprusside to Treat No-Reflow after Primary Percutaneous Coronary Intervention in Acute Myocardial Infarction

• Published in: Herz Vol. 35; no. 2; pp. 114 - 118
• Main Authors: Tesic, Milorad B., Stankovic, Goran, Vukcevic, Vladan, Ostojic, Miodrag C.
• Format: Journal Article
• Language: English
• Published: Munchen Urban and Vogel 01-03-2010; Springer Nature B.V
• Subjects: Angioplasty, Balloon, Coronary - methods; Cardiology; Coronary Angiography; Coronary Artery Bypass; Coronary Restenosis - diagnostic imaging; Coronary Restenosis - therapy; Coronary Vessels - drug effects; Female; Graft Occlusion, Vascular - diagnostic imaging; Graft Occlusion, Vascular - therapy; Humans; Injections; Internal Medicine; Male; Medicine; Medicine & Public Health; Middle Aged; Myocardial Infarction - diagnostic imaging; Myocardial Infarction - therapy; Nitroprusside - administration & dosage; No-Reflow Phenomenon - diagnostic imaging; No-Reflow Phenomenon - drug therapy; Postoperative Complications - diagnostic imaging; Postoperative Complications - therapy; Vasodilator Agents - administration & dosage; Veins - transplantation; SVG; Complications; Aortokoronarer Venenbypass; Percutaneous coronary intervention; Stent; No-reflow; Sodium nitroprusside; No-Reflow-Phänomen; Komplikation; Nitroprussidnatrium; PCI; Perkutane koronare Intervention; Stents
• ISSN: 0340-9937; 1615-6692
• DOI: 10.1007/s00059-010-3243-4

Background:
The no-reflow phenomenon is characterized by an inadequate myocardial tissue perfusion in the presence of a patent epicardial coronary artery. The incidence of no-reflow appears to be highest in patients undergoing primary percutaneous coronary intervention (PCI) in acute myocardial infarction or during PCI of saphenous vein grafts (SVGs). Treatment of no-reflow phenomenon is based on the intracoronary administration of medications that induce vasodilatation in small distal coronary vasculature. Sodium nitroprusside (NTP) is a direct nitric oxide donor and does not require intracellular metabolism to induce vasodilatation in microcirculation.
Case Study:
Two patients are reported, in whom no-reflow following primary PCI of SVG and native coronary artery was successfully treated with intracoronary NTP. Repeated injections of 50 μg NTP were given selectively distal to the occlusion site utilizing coronary microcatheter (a total NTP dose of 200 μg was given in both cases). Because of the extremely short half-life, the use of intracoronary NTP was easily tolerated by both patients, without causing prolonged or profound hypotension.
Conclusion:
The authors therefore propose the use of NTP for treatment of no-reflow phenomenon in both vein grafts and native coronary arteries in the setting of acute myocardial infarction.