Tesic Milorad B, Stankovic Goran, Vukcevic Vladan, Ostojic Miodrag C
Department of Cardiology, Clinical Center of Serbia, Koste Todorovica 8, 11000 Belgrade, Serbia.
Herz. 2010 Mar;35(2):114-8. doi: 10.1007/s00059-010-3243-4. Epub 2010 Apr 8.
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.
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 microg NTP were given selectively distal to the occlusion site utilizing coronary microcatheter (a total NTP dose of 200 microg 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.
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.
无复流现象的特征是在冠状动脉主干通畅的情况下心肌组织灌注不足。无复流现象的发生率似乎在急性心肌梗死接受直接经皮冠状动脉介入治疗（PCI）的患者或隐静脉移植血管（SVG）的PCI过程中最高。无复流现象的治疗基于冠状动脉内给予能使远端小冠状动脉血管舒张的药物。硝普钠（NTP）是一种直接的一氧化氮供体，在微循环中诱导血管舒张不需要细胞内代谢。
报道了2例患者，他们在SVG和自身冠状动脉的直接PCI术后出现的无复流现象通过冠状动脉内给予NTP成功得到治疗。使用冠状动脉微导管在闭塞部位远端选择性地重复注射50微克NTP（2例患者NTP总剂量均为200微克）。由于半衰期极短，冠状动脉内使用NTP很容易被2例患者耐受，未引起长时间或严重低血压。
因此，作者建议在急性心肌梗死情况下，使用NTP治疗静脉移植血管和自身冠状动脉中的无复流现象。
