Key result
Intracoronary adrenaline successfully resolves multivessel no-reflow after balloon rupture, restoring TIMI-3 flow.
Why the study?
Coronary no-reflow is an independent predictor of mortality and its management, especially in multiple vessels, requires effective treatment strategies.
Does intracoronary adrenaline improve coronary flow and hemodynamics in a patient with multi-vessel no-reflow complicating primary PCI?
Case Report (n=1)
No
Does intracoronary adrenaline improve coronary flow and hemodynamics in a patient with multi-vessel no-reflow complicating primary PCI?
Intracoronary adrenaline (250 µg) can effectively and safely reverse life-threatening multi-vessel no-reflow complicated by hypotension during primary percutaneous coronary intervention.
Intracoronary adrenaline may rescue multivessel no-reflow after balloon rupture; hypothesis-generating and unproven for routine PCI use.
Background: Coronary no-reflow is characterized by very slow or absent epicardial blood flow. It results in inadequate myocardial perfusion and is an independent predictor of mortality due to malignant arrhythmias and heart failure. Case Illustration: This case describes a patient who underwent angiography due to a reperfused inferior myocardial infarction. Following the diagnostic procedure, a decision was made to perform a primary percutaneous intervention on the Circumflex (Cx) artery. When the stent balloon was inflated to the optimal pressure, it burst. The control image revealed the development of no-reflow after the Left Main Coronary Artery (LMCA). This potentially fatal condition was successfully treated with the administration of Intracoronary (IC) adrenaline. Conclusion: No-reflow is a significant factor affecting mortality. The occurrence of this phenomenon in multiple vessels further increases this risk, but it can be effectively managed with IC adrenaline, and multiple-vessel no-reflow can be treated.
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Çakır et al. (2026) conducted a case report in Coronary no-reflow / Acute Coronary Syndrome (n=1). Intracoronary adrenaline was evaluated on Coronary blood flow restoration (TIMI flow grade). Intracoronary administration of 250 µg adrenaline successfully restored TIMI-3 distal flow and resolved multiple-vessel no-reflow following a proximal stent balloon rupture.
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