Supersaturated Oxygen Therapy as a Treatment for No Reflow

Abstract

No reflow, an interruption in epicardial and microvascular blood flow, during percutaneous coronary intervention (PCI) is associated with adverse outcomes but continues to have limited therapeutic options. We present a case of a patient with multiple comorbidities, multivessel disease and reduced left ventricular function with calcified left anterior descending stenosis who was treated with rotational atherectomy, complicated by slow flow after balloon dilatation. Infusion of supersaturated oxygen (SSO₂) into the left main was instituted as an adjunct to PCI, along with pharmacologic vasodilators. Subsequently, there was resolution of the patient’s symptoms and improvement in ejection fraction postprocedurally. The potential role of SSO₂ in treating patients with intraoperative no reflow is intriguing, given no reflow’s current limited treatment options and known increased risk of adverse events (major adverse cardiovascular events, cardiogenic shock, and so on). SSO₂ may be a promising therapy for PCI complicated by no reflow.