Intracoronary adenosine administered during rotational atherectomy of complex lesions in native coronary arteries reduces the incidence of no-reflow phenomenon

Assessment of the Histological Characteristics of Coronary Arterial Plaque With Severe Calcification

“…[1][2][3][4] During ablation of the plaque, microparticles are produced by the advancing burr and experimental studies suggested that these particles pass harmlessly through the distal microcirculation. 10,19 However, several clinical studies have shown that RA is associated with higher rates (6-15%) of the no-reflow/slow-flow phenomenon than other coronary revascularization procedures, [5][6][7][8][9] and this phenomenon can lead to serious ischemic complications, such as conduction disturbances, myocardial infarction, cardiogenic shock or even death. 20 It has been reported that high-speed rotablation might cause aggregation platelet activation of platelet-rich plasma and distal flow disturbance during RA procedures.…”

Effect of Intracoronary Nicorandil Administration on Preventing No-Reflow/Slow Flow Phenomenon During Rotational Atherectomy

“…15,16 During ablation of the plaque, microparticles are produced by the advancing burr and although experimental studies suggest that these particles pass harmlessly through the distal microcirculation, 17,18 the no-reflow/slow flow phenomenon occurs in 6-15% of patients in clinical studies of RA. 5,13,19 It is therefore important to establish clinically the treatment of the no-reflow /slow flow phenomenon, but to date, there are no uniform strategies for managing this phenomenon. In the present study, we showed that the continuous intracoronary infusion of nicorandil during RA procedures was easy, safe and more effective in preventing the no-reflow/slow flow phenomenon than verapamil.…”

“…27 Recently, Hanna et al reported that intracoronary administration of adenosine, which improves coronary microvascular circulation in a similar manner to nicorandil, reduced the incidence of the no-reflow phenomenon during RA procedures. 13 However, when compared with adenosine, nicorandil has several advantages. First, nicorandil also dilates epicardial coronary arteries, and this effect can relieve refractory coronary spasm for which nitrates are not fully effective.…”

No-Reflow Phenomenon

“…A second retrospective study confirmed these benefits in patients undergoing rotational atherectomy. 122 Because opening ATP-sensitive potassium channels may be involved in the vasodilatory effect of adenosine, a direct ATP potassium channel opener, nicorandil, was attempted in treating the no-reflow phenomenon. Sakata et al 123 reported a 54-year-old patient with anterior myocardial infarction who, despite responding to thrombolytic therapy, had a large no-reflow zone.…”