How to manage no reflow phenomenon with local drug delivery via a rapid exchange catheter.

We describe two cases of no reflow phenomenon in the setting of primary PCI for ST elevation myocardial infarction successfully managed with intracoronary vasodilator therapy via a Clearway™ balloon catheter, where vasodilator therapy via the guiding catheter had been ineffective. Traditionally, if not given via the guiding catheter, vasodilators have been administered via an over-the-wire balloon catheter, which can be cumbersome and time consuming. The Clearway catheter is a rapid exchange balloon catheter affording rapid delivery of vasodilators to the distal infarct related artery without risk of loss of wire position. © 2010 Wiley-Liss, Inc.