JACC Case Rep. 2026 Aug 13:109740. doi: 10.1016/j.jaccas.2026.109740. Online ahead of print.
ABSTRACT
BACKGROUND: Refractory coronary no-reflow (CNR) during primary percutaneous coronary intervention lacks an established, sustained localized management strategy when conventional intracoronary bolus therapies fail.
CASE SUMMARY: 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.
DISCUSSION: 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 | DOI:10.1016/j.jaccas.2026.109740