Coronary No-reflow Phenomenon.

No-reflow occurs in up to one third of patients with acute myocardial infarction during acute percutaneous intervention, and occasionally during elective interventions, particularly vein graft intervention. Multiple intracoronary medications will restore flow in most cases. We begin with 100 to 1000 mg of nitroprusside, verapamil, or adenosine at a similar dosage. We give it at 100-mg increments at high velocity. We inject it distally in the epicardial artery to avoid any systemic effect, and we do it through an intracoronary perfusion catheter. At times, we use prophylactic injections (prior to balloon inflation), particularly in vein graft intervention. Most of these strategies are not formally approved for treating no-reflow. However, reversing this condition with restoration of normal coronary flow is essential for an improved left ventricular function and a better cardiac outcome.