In the setting of MI, several drugs have been shown to reduce the incidence of no-reflow. Evidence for a beneficial effect on no-reflow exists for abciximab, adenosine, nic- orandil, and nitroprusside.674,675,680,682,683,685,687,688,690 How- ever, their adoption into clinical practice has depended on their effect on hard clinical endpoints such as infarct size and mortality. These benefits, and consequentially the use of these agents, have been limited. For interventional no-reflow, several therapies have proven effective after no-reflow has started. These include adeno- sine, calcium channel blockers, and nitroprus- side.676,678,679,681,684,686,689,691 There are fewer data to support the use of epinephrine.692 No-reflow after rotational atherec- tomy was less common with nicorandil compared with verapamil infusions in 3 studies,693 695 and an infusion of nicorandil/adenosine during rotational atherectomy prevented no-reflow in 98% of patients.677 Trials of pre-PCI intracoro- nary verapamil, nicardipine, and adenosine have reported them to be safe but have not demonstrated reductions in post-PCI no-reflow.696 698 Mechanical devices to prevent interventional and myocardial infarct reperfusion no-reflow are also covered in Section 5.5.5. 5.8. PCI in Specific Anatomic Situations 5.8.1. CTOs: Recommendation Class IIa 1. PCI of a CTO in patients with appropriate clinical indications and suitable anatomy is reasonable when performed by operators with appropriate exper- tise.699 703 (Level of Evidence: B) See Online Data Supplements 26 to 28 for additional data regarding CTOs. 