What is your stepwise approach to managing no re-flow during PCI?   

Verapamil or nitroprusside IC depending on presentation. Aspiration thrombectomy if latter ineffective. 

Adenosine delivered to the distal coronary with a Pronto catheter (easy to use and available if aspiration also necessary. Rarely use it otherwise).  Then Verapamil and NTG (it is already at the table for a radial cocktail, even though NTG is for epicardial spasm).  Nitroprusside next.