A Case of No-reflow Phenomenon Improved by Intracoronary Nitroprusside Injection with Lumine™ Infusion Catheter

No-reflow phenomenon is a condition in which blood flow to the ischemic myocardium is significantly reduced despite percutaneous coronary intervention. So far, a standard treatment to improve this condition has not been established. We here report an interesting case that illustrates an effective treatment for no-reflow phenomenon. A 66-year-old male was admitted to our hospital for acute myocardial infarction and underwent emergent catheterization. Coronary angiogram showed total obstruction of the distal right coronary artery (RCA). We used an AL2 guiding catheter and passed a coronary guidewire into the RCA. Coronary flow was then slightly restored, and severe stenosis of the distal RCA with massive thrombus was observed. Intravascular ultrasound revealed that the thrombus was large and diffuse. Firstly, thrombus aspiration was performed. Then, no-reflow phenomenon was observed in the far distal RCA. An infusion catheter (Lumune™) was advanced to the distal RCA and 50 μg nitroprusside was injected. Thrombolysis in Myocardial Infarction (TIMI) flow grade 3 was immediately achieved. Two weeks after the first catheterization, a second catheterization was performed. Coronary angiogram showed no stenosis in the RCA and most of the thrombus disappeared. Left ventriculography showed severe hypokinesis of the inferior wall, but ejection fraction increased to 59%. He was discharged and has been followed as an outpatient at our hospital. We experienced a case of no-reflow phenomenon clearly ameliorated by intracoronary nitroprusside injection with a Lumine™ infusion catheter. This method could be a powerful option to treat no-reflow phenomenon.