Key result
Marinade technique intracoronary fibrinolysis restores coronary flow in refractory no-reflow after heart transplant.
Why the study?
The role of intracoronary fibrinolysis with distal occlusion (the Marinade technique) in managing refractory no-reflow during STEMI in heart transplant recipients remains unknown.
Does rescue intracoronary fibrinolysis using the Marinade technique improve coronary flow in a heart transplant recipient with STEMI complicated by refractory no-reflow?
Case Report (n=1)
No
Does rescue intracoronary fibrinolysis using the Marinade technique improve coronary flow in a heart transplant recipient with STEMI complicated by refractory no-reflow?
Intracoronary fibrinolysis using the Marinade technique may be an effective bailout strategy for refractory no-reflow during PCI in high-risk patients such as heart transplant recipients, even while on VA-ECMO.
May support bailout use in refractory no-reflow during transplant PCI on ECMO; leaves open need for prospective validation.
Background: The role of the Intracoronary fibrinolysis with distal occlusion (the Marinade technique) in managing refractory no-reflow during ST-segment elevation myocardial infarction in heart transplant recipients remains unknown. Case presentation: We report a case of a 38-year-old heart transplant recipient who presented with anterior ST-segment elevation myocardial infarction caused by total occlusion of the proximal left anterior descending artery. Despite repeated balloon dilations and thrombus aspiration, severe refractory no-reflow persisted and was complicated by ventricular fibrillation cardiac arrest requiring venoarterial-extracorporeal membrane oxygenation (VA-ECMO) support. Rescue intracoronary fibrinolysis using the Marinade technique-consisting of distal balloon occlusion and localized alteplase delivery with a prolonged dwell time-was repeatedly performed, resulting in partial restoration of coronary flow. Additional selective distal intracoronary alteplase administration via aspiration catheter successfully re-established distal coronary perfusion and thereby allowed completion of percutaneous coronary intervention (PCI). A total intracoronary alteplase dose of 25 mg was administered without major bleeding complications, despite concurrent VA-ECMO support. Although ST-segment resolution was limited, chest pain improved and hemodynamic stabilization was achieved, enabling successful redo heart transplantation. Conclusion: This case highlights the potential utility of intracoronary fibrinolysis using the Marinade technique as a bailout strategy for refractory no-reflow during PCI, even in high-risk settings such as heart transplant recipients with advanced microvascular dysfunction.
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Kim et al. (2026) conducted a case report in STEMI with refractory no-reflow (n=1). Intracoronary fibrinolysis (Marinade technique) using alteplase was evaluated on Restoration of distal coronary flow. Rescue intracoronary fibrinolysis using the Marinade technique with up to 25 mg of alteplase successfully restored distal coronary flow and stabilized hemodynamics in a heart transplant recipient with STEMI and refractory no-reflow.
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