Pharmaceutical Interventions for the Management of No-Reflow

Tim A. Fischell, MD

J Invasive Cardiol. 2008;20(7):374-379. 

In This Article


Adenosine is a primordial cell-signal mediator with activities implemented through interaction with specific receptors.[32] Adenosine inhibits platelet activation, impedes platelet aggregation, and is a potent arteriolar dilator that has been shown to reduce the incidence of no-reflow following PCI in native vessels, and reverse – but not prevent–no-reflow in degenerated SVGs.[33,34] IC adenosine has an extremely short half-life and duration of action, and thus requires repetitive dosing during PCI.

In a prospective, randomized, placebo-controlled trial to study the effect of IC injection of adenosine, verapamil or placebo in a mixed population with ACS, adenosine administered after PCI significantly improved coronary flow and wall motion index as assessed by thrombolysis in myocardial infarction (TIMI) frame count (TFC), even when flow was visually established to be normal or near normal.[35] In two series, multiple rapid bolus administrations of adenosine via a guiding catheter safely reversed no-reflow to baseline or TIMI 3 flow in more than 90% of patients receiving high-dose regimens, with one study documenting the consistent onset of improvement within a mean of 3–5 minutes following initial injection.[34,36]


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