الفهرس 
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Abstract
Coronary No Reflow is major obstacle faced by any interventionist during PPCI occurring in up to 40 % of the patients with STEMI. In the absence of any sort of tailored algorithms or clues as to how to manage this common complication, this makes it open to significant variations in proper management of CNR.
Large number of studies is being done to understand and better handle this complication. Many theories postulates that CNR is multifactorial including distal embolization of the thrombus into the capillary bed, coronary vasospasm, microvascular dysfunction due to inflammation caused by the infarcted necrotic tissue and reperfusion injury.
Many solutions both mechanical and pharmacological have been delivered to clear up the CNR problem, but none have verified superiority enough to be used routinely in CNR.
We have compared between two agents adrenaline and verapamil in the management of CNR and found out that verapamil is better in both immediate and short -term outcomes. It was superior to adrenaline in improving TFG and MBG. It also nearly caused a mean rise of 20 % in EF of all the patient in contrast to the 10 % seen in the adrenaline and control group.
Summary
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We also concluded that adrenaline was inferior to the standard treatment protocol used in both immediate and short -term outcomes.
We recommend that we use the verapamil as a part of the standard treatment protocol when faced by CNR while we still need more studies to prove the benefit of adrenaline in CNR settings.
Fighting the no reflow should be broad spectrum until such time we have a deep insight to the main pathology behind it