Primary angioplasty after distal intracoronary infusion of nicorandil solution mixed with contrast media.

A 50-year-old woman presented with history of intermittent angina for 2 days and signs of extensive anterior wall myocardial infarction. An urgent coronary angiogram showed a large proximally occluded left anterior descending (LAD) artery with no distal vessel opacification. After one attempt of thrombus aspiration, there was no improvement in Thrombolysis in Myocardial Infarction (TIMI) flow. The aspiration catheter was then parked in the distal vessel beyond the thrombotic lesion and 2 mg of intravenous nicorandil drug mixed with 10 mL of 50% dilute iodinated contrast media was infused slowly. A comparison was made to proximal vessel angiogram and the angioplasty procedure was then completed with a right size stent, restoring TIMI 3 flow in the LAD. This method minimises clot manipulations by avoiding repeated balloon predilatations or thrombus aspiration attempts and thus prevents the occurrence of no-reflow in lesions with large thrombus burden. © BMJ Publishing Group Limited 2020. No commercial re-use. See rights and permissions. Published by BMJ.