Table 2

Interventions used in clinical situations to reduce no-reflow

InterventionClinical situationMethod for assessing no-reflowComment
AMI, acute myocardial infarction; MCE, myocardial contrast echocardiography; PTCA, percutaneous transluminal coronary angioplasty; TIMI, thrombolysis in myocardial infarction.
Adenosine
Intracoronary adenosinePrimary angioplasty for AMITIMI grade flowIncidence of angiographic no-reflow could be reduced, and in one study associated with better recovery of left ventricular function and outcome
Calcium antagonists
Intracoronary verapamil with glyceryl trinitrateElective and emergency PTCA for AMITIMI grade flowImprovement of TIMI grade flow after verapamil in elective and emergency PTCA
Intracoronary verapamilPTCA in AMIMCEReduction of perfusion defects and increase in peak intensity, associated with better contractile recovery
Intragraft verapamilElective PTCATIMI grade flowImprovement of flow with verapamil in PTCA in saphenous grafts, in contrast: no effect of glyceryl trinitrate
Papaverine
Intracoronary papaverineElective PTCA in saphenous graftsTIMI frame countPapaverine reduced the number of TIMI frame counts in patients with no-reflow
Nicorandil
Intravenous nicorandilAnterior wall AMIMCELower incidence of perfusion defects in the nicorandil group
Nitric oxide donor
Intracoronary nitroprussideElective PTCATIMI flow grade, modified TIMI
frame count
Improvement of flow after nitroprusside in elective interventions
Glycoprotein IIb/IIIa receptor antagonism
Intravenous abciximabStenting in AMICoronary flow velocity after 14 daysImprovement of coronary flow velocities and left ventricular function after myocardial infarction with abciximab
Intravenous eptifibatideElective stenting of native coronary arteriesAngiography derived flow reserve and myocardial blushEptifibatide improved parameters of coronary flow reserve and velocity of microvascular perfusion in elective PTCA procedures
Intravenous abciximabElective rotational atherectomyTc-99m sestamibi scintigraphyAbciximab reduced the incidence and amount of scintigraphic perfusion defects after rotational atherectomy
Mechanical devices for prevention of microembolisation (distal temporary occlusion versus umbrella technique)
For example, PercuSurge GuardWire temporary occlusion system, Dorros/Probing catheter, Angiogard (“umbrella” system)Elective saphenous graft angioplastyFirst experiences, feasibilityIn saphenous graft interventions large amounts of atherosclerotic debris could be aspirated.