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The Use of Intracoronary Sodium Nitroprusside to Treat No-Reflow after Primary Percutaneous Coronary Intervention in Acute Myocardial Infarction

Die intrakoronare Anwendung von Nitroprussidnatrium zur Behandlung vaskulärer Reperfusionsschäden durch das No-Reflow-Phänomen nach primärer perkutaner koronarer Intervention bei akutem Myokardinfarkt

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Abstract

Background:

The no-reflow phenomenon is characterized by an inadequate myocardial tissue perfusion in the presence of a patent epicardial coronary artery. The incidence of no-reflow appears to be highest in patients undergoing primary percutaneous coronary intervention (PCI) in acute myocardial infarction or during PCI of saphenous vein grafts (SVGs). Treatment of no-reflow phenomenon is based on the intracoronary administration of medications that induce vasodilatation in small distal coronary vasculature. Sodium nitroprusside (NTP) is a direct nitric oxide donor and does not require intracellular metabolism to induce vasodilatation in microcirculation.

Case Study:

Two patients are reported, in whom no-reflow following primary PCI of SVG and native coronary artery was successfully treated with intracoronary NTP. Repeated injections of 50 μg NTP were given selectively distal to the occlusion site utilizing coronary microcatheter (a total NTP dose of 200 μg was given in both cases). Because of the extremely short half-life, the use of intracoronary NTP was easily tolerated by both patients, without causing prolonged or profound hypotension.

Conclusion:

The authors therefore propose the use of NTP for treatment of no-reflow phenomenon in both vein grafts and native coronary arteries in the setting of acute myocardial infarction.

Zusammenfassung

Hintergrund:

Das No-Reflow-Phänomen ist durch eine unzureichende Versorgung des Herzmuskels bei offenen epikardialen Koronararterien gekennzeichnet. Die höchste Inzidenz scheinen Patienten mit primärer perkutaner koronarer Intervention (PCI) bei akutem Myokardinfarkt oder während PCI aortokoronarer Venenbypässe (SVG [„saphenous vein grafts“]) aufzuweisen. Die Behandlung des No-Reflow-Phänomens stützt sich auf die intrakoronare Verabreichung von Medikamenten, welche die kleinen distalen koronaren Gefäße erweitern. Nitroprussidnatrium (NTP), ein direkter Stickoxiddonor, ist hierfür bestens geeignet, da es keinen intrazellulären Stoffwechsel benötigt, um Vasodilatation in der Mikrozirkulation zu bewirken.

Fallbericht:

Vorgestellt werden zwei Patienten, bei denen ein No-Reflow-Phänomen nach primärer PCI eines Venenbypasses und einer nativen Koronararterie mit intrakoronarer Gabe von NTP erfolgreich behandelt wurde. Wiederholte Injektionen von 50 μg NTP wurden selektiv distal der Okklusion mittels eines koronaren Mikrokatheters verabreicht (NTP-Gesamtdosis in beiden Fällen 200 μg). Aufgrund der extrem kurzen Wirkung wurde die intrakoronare NTP-Gabe gut vertragen und führte zu keiner signifikanten Hypotonie.

Schlussfolgerung:

Die Autoren schlagen deshalb die Verwendung von NTP zur Behandlung des No-Reflow- Phänomens sowohl in Venenbypässen als auch in nativen Koronararterien bei Patienten mit akutem Myokardinfarkt vor.

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Authors and Affiliations

  1. Department of Cardiology, Clinical Center of Serbia, Belgrade, Serbia

    Milorad B. Tesic, Goran Stankovic MD, PhD, ESC, FACC, Vladan Vukcevic & Miodrag C. Ostojic

  2. Department of Cardiology, Clinical Center of Serbia, Koste Todorovica 8, 11000, Belgrade, Serbia

    Goran Stankovic MD, PhD, ESC, FACC

Authors
  1. Milorad B. Tesic
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  2. Goran Stankovic MD, PhD, ESC, FACC
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  3. Vladan Vukcevic
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  4. Miodrag C. Ostojic
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Corresponding author

Correspondence to Goran Stankovic MD, PhD, ESC, FACC.

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Tesic, M.B., Stankovic, G., Vukcevic, V. et al. The Use of Intracoronary Sodium Nitroprusside to Treat No-Reflow after Primary Percutaneous Coronary Intervention in Acute Myocardial Infarction. Herz 35, 114–118 (2010). https://doi.org/10.1007/s00059-010-3243-4

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  • DOI: https://doi.org/10.1007/s00059-010-3243-4

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