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No-reflow is a common complication of percutaneous coronary intervention (PCI) (primary, acute coronary syndrome, stable coronary disease and graft vessel disease) with adverse outcomes. Microvascular obstruction of downstream bed is the culprit. Intracoronary administration of various calcium channel blockers, nikorandil, adenosine, abciximab, sodium nitroprusside, thrombus aspiration and temporary pacing are the treatment options. The goal of this study was to evaluate the efficacy of intracoronary autologus blood transfusion (ABT) in reversing no-reflow during PCI as data regarding its effectiveness are limited.
Between May 2014 to June 2016, 89 patients (67 male, 22 female; mean age-46.4 years) had received ABT during PCI to treat no-reflow. 100-120 ml of blood was withdrawn through guiding catheter over 3-minute using 10 mi syringe and re-infused by forceful injection over 2-minute period to reverse no-reflow and its efficacy was assessed by TIMI flow and frame count method (TFC) at 15 minute.
No-reflow was seen in primary (n=22; 24.8%), rescue (n=8; 8.9%), pharmaco-invasive (n=31; 34.9%), elective (n=26; 29.2%) and graft vessel (n=2; 2.2%) PCI. A mean of 108±4 ml of blood was transfused. Culprit artery was left anterior descending in 39(43.9%), right coronary in 29(32.6%) and circumflex artery in 21(23.5%) patients. TIMI 3 flow was successfully restored in 62(69.7%), TIMI 1/2 in 18(20.2%) and TIMI 0 in 9(10.1%) of patients. TFC decreased from 56±39 to 18±11 after ABT (P =0.04). ABT was well tolerated without any adverse hemodynamic consequences. Transient hypotension was noted among 7(7.9%) patients who recovered after completion of transfusion.
In this largest series to date, intracoronary transfusion of autologus blood through guiding catheter is safe and highly effective non-pharmaco non-invasive approach to reverse no-reflow during PCI. Possible mechanism of action is rise of driving pressure across the capillary bed to overcome microvascular obstruction. Key Words-Autologus blood transfusion; No-reflow; Percutaneous coronary intervention; Acute coronary syndromes; TIMI frame count