Role of Distal Intracoronary Adenosine in Treatment of Abrupt Coronary Occlusion

Objectives:

• We intend to show a novel way to deliver vasoactive medications in patients with no-reflow in the setting of coronary intervention.
• Review of grading system to assess reperfusion of affected myocardium.
• Examples of clinical vignettes with successful opening of compromised vessels with distal intracoronary injection of Adenosine. (Actual cine will be shownduring presentaion)

Introduction: No-reflow phenomenon is defined as inadequate myocardial perfusion despite patent artery without evidence of distal occlusion.

• It manifests angiographically as TIMI flow less than 3 without mechanical obstruction.
• Incidence of no-reflow is variable with most studies reporting the incidence between 2% and 39%.
• Intracoronary infusion of Adenosine, Verapamil, Nipride and GP2b IIIa inhibitors have been used in the treatment of no reflow phenomenon usually through guide catheter to proximal vessel
• There is no convincing evidence that one of these modalities is associated with a better outcome
• • No reflow is associated with higher cardiac markers, arrhythmias, heart failure and mortality.
  • Myocardial Blush is a useful grading system to assess reperfusion of infarcted myocardium.
• Conclusions
• • We present a novel option to reverse no reflow and restore TIMI -3 flow in the affected coronary vessels during coronary intervention after the culprit lesion was successfully treated.
  • Adenosine was given via the central lumen of over the wire balloon (after wire was removed) into the distal coronary circulation.
  • A single dose of 12 mg of Adenosine was used without any systemic side effects. (Half life of Adenosine is too short for any systemic side effects)
  • Further studies are required