Refractory Coronary No-Reflow Reversed by Prolonged Intracoronary Nitroprusside Via an Innovative Microcatheter.

Authors

Yanfu Wang, Xiaolu Li, Wei Li, Minglian Gong, Yi Mao

Published in

JACC. Case reports. Pages 109740. Aug 13, 2026. Epub Aug 13, 2026.

Abstract

Refractory coronary no-reflow (CNR) during primary percutaneous coronary intervention lacks an established, sustained localized management strategy when conventional intracoronary bolus therapies fail.
We present 2 patients with delayed ST-segment elevation myocardial infarction presentation (>43 hours) who developed refractory CNR (TIMI flow grade 0-1) during rescue percutaneous coronary intervention despite repeated thrombectomy and standard vasodilator boluses. An innovative arterial infusion microcatheter was indwelled locally. A prolonged, targeted bedside sodium nitroprusside infusion fixed pump rate of 8 μg/min was maintained for 8 to 12 hours. This novel approach safely reversed microvascular obstruction, automatically resolved full atrioventricular block, and achieved complete delayed angiographic restoration of TIMI flow grade 3, significantly preserving ventricular function.
Localized prolonged sodium nitroprusside delivery via a stable indwelling microcatheter provides an effective bailout strategy to CNR and salvage extensive hibernating myocardium beyond the traditional reperfusion time window and help to recover the blood flow.

PMID:
42593376
Bibliographic data and abstract were imported from PubMed on 13 Aug 2026.

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