{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T09:28:22Z","timestamp":1786613302067,"version":"build-2736575974"},"reference-count":20,"publisher":"MDPI AG","issue":"16","license":[{"start":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T00:00:00Z","timestamp":1786579200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background\/Objectives: The optimal intracoronary drug delivery strategy for the management of the no-reflow phenomenon (NRP) during percutaneous coronary intervention (PCI) remains uncertain. We compared distal and proximal intracoronary drug administration for the treatment of NRP. Methods: This retrospective single-center study included 212 consecutive patients who developed NRP following drug-eluting stent implantation between January 2022 and June 2025. Patients were treated with intracoronary medications administered either proximally through the guiding catheter (n = 107) or distally using a microcatheter or guide extension catheter (n = 105). The primary outcome was the restoration of final Thrombolysis in Myocardial Infarction (TIMI) grade 3 flow. Multivariable logistic regression with bootstrap internal validation was performed. Results: Despite a higher prevalence of baseline TIMI 0 flow (85.7% vs. 19.6%, p &lt; 0.001) and higher SYNTAX scores in the distal group, distal drug administration achieved a higher rate of final TIMI grade 3 flow (66.7% vs. 27.1%, p &lt; 0.001) and final TIMI grade 2\u20133 flow (90.5% vs. 73.8%, p = 0.003). Distal administration remained an independent predictor of final TIMI grade 3 flow (adjusted OR 15.94, 95% CI 5.22\u201348.69; p &lt; 0.001), with consistent findings in a sensitivity analysis accounting for adjunctive intracoronary pharmacological therapy. The optimism-corrected area under the receiver operating characteristic curve was 0.707. No significant between-group differences were observed in in-hospital or 6-month clinical outcomes. Conclusions: Distal intracoronary drug administration was associated with a higher likelihood of achieving TIMI grade 3 flow than conventional proximal administration. These findings should be considered hypothesis-generating and require confirmation in prospective randomized studies.<\/jats:p>","DOI":"10.3390\/jcm15166252","type":"journal-article","created":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T08:06:16Z","timestamp":1786608376000},"page":"6252","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Distal Versus Proximal Intracoronary Drug Delivery for the Treatment of the No-Reflow Phenomenon During Percutaneous Coronary Intervention"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1320-9033","authenticated-orcid":false,"given":"Umeyir","family":"Savur","sequence":"first","affiliation":[{"name":"Department of Cardiology, Istanbul Medipol University, Medipol Mega University Hospital, 34214 Istanbul, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5879-2245","authenticated-orcid":false,"given":"Berhan","family":"Keskin","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Istanbul Medipol University, Medipol Mega University Hospital, 34214 Istanbul, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2898-741X","authenticated-orcid":false,"given":"Irem","family":"Koc","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Istanbul Medipol University, Medipol Mega University Hospital, 34214 Istanbul, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-8534-4016","authenticated-orcid":false,"given":"Yerkenur","family":"Khidolda","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Istanbul Medipol University, Medipol Mega University Hospital, 34214 Istanbul, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5074-5340","authenticated-orcid":false,"given":"Atakan","family":"Dursun","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Istanbul Medipol University, Medipol Mega University Hospital, 34214 Istanbul, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4066-6822","authenticated-orcid":false,"given":"Aysel","family":"Akhundova","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Istanbul Medipol University, Medipol Mega University Hospital, 34214 Istanbul, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8252-0373","authenticated-orcid":false,"given":"Aykun","family":"Hakgor","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Istanbul Medipol University, Medipol Mega University Hospital, 34214 Istanbul, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5825-8627","authenticated-orcid":false,"given":"Haci Murat","family":"Gunes","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Istanbul Medipol University, Medipol Mega University Hospital, 34214 Istanbul, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4951-6716","authenticated-orcid":false,"given":"Bilal","family":"Boztosun","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Istanbul Medipol University, Medipol Mega University Hospital, 34214 Istanbul, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,13]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Ozaki, Y. 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