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The aim of this article is to provide a brief and concise review of the current understanding of the pathophysiology, clinical predictors, and investigations and management of coronary no-reflow phenomenon.Ĭoronary no reflow. Several investigative and treatment strategies within and outside the cardiac catheterization laboratory have been proposed, but have not uniformly shown success in reducing mortality or in preventing adverse left ventricular remodeling resulting from this condition. However, the exact mechanism in humans is still poorly understood. Several mechanisms such as ischemia-reperfusion injury and distal microthromboembolism in genetically susceptible patients and those with preexisting endothelial dysfunction have been implicated. Incidence of this phenomenon is high following percutaneous intervention, and is associated with adverse in-hospital and long-term outcomes. 2015 Jul 45(4): 259-265.Buy Article Permissions and Reprints AbstractĬoronary no-reflow phenomenon is a lethal mechanism of ongoing myocardial injury, following successful revascularization of an infarct-related coronary artery. Role of Intravascular Ultrasound in Patients with Acute Myocardial Infarction - ArticleĪuthors: Young Joon Hong, MD, Youngkeun Ahn, MD, and Myung Ho Jeong, MD.Prediction of no-reflow and major adverse cardiovascular events with a new scoring system in STEMI patients.Link title - ArticleĪuthors:Bayramoglu A, Ta§olar H, Kaya A, Tanboga 1H, Yaman M, Bekta§ 0, GUnaydin ZY, Oduncu V.Advances in Coronary No-Reflow Phenomenon-a Contemporary Review- Article.Acute Myocardial Infarction in patients presenting with ST-segment elevation (Management of) ESC 2017 Clinical Practice Guidelines - ArticleĪuthors: Borja Ibanez (Chairperson) (Spain).
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The final angiographic & hemodynamic results were satisfactory.Ĭontraste medium: Optiray 350 (Guerbet): 179ml. POT was performed with a 5.0x8mm balloon, the patient has experienced again a Ventricular fibrillation during balloon infation. Third Xience Sierra (abbott) 4.0x28mm was implanted on the left main to the Proximal LAD with some plaque shift to the Left circumflexe artery. IVUS was used to control LAD stents deployment & assessment of the distal Left main stenosis. Second short stent Xience Sierra 2.75x8mm(Abbott) was implanted to cover distal edge dissection. The angiographic control with Tip injection through the Export catheter showed sgnificant flow improvement. Thrombo-aspiration cathter Export 6F (Medtronic) was used to deliver distally repetitive Adenosine Bolus. The angiographic control revealed LAD "non reflow ". Predilatation with 2.0x20mm balloon has been performed.įirst stent implantation: Xience Sierra 3.0x28mm (Abbott) in the proximal-Mid LAD inflated at 12ATM. The Sion black guidewire alone has failed to cross the lesion.Ĭonventional balloon support (Rapid Exchange) has also failed to facilitate crossing the lesion.įinally the lesion was crossed succesfully with Sion black guidewire & CTO dedicated microcatheter (Turnpike LP: Teleflex) support. Left system angiography showed distal Left main significant lesion & proximal LAD thrombotic occlusion. The patient has experienced repetitive cardiac arrest due to ventricular fibrillation, so he was intubated & admitted to cath-lab.įirst coronary angiography: right system first.ĮBU 3.5 6F guiding catheter used for the left system. IVUS guidance to control stent deployment & Left main stenting during primary PCI.
#NO REFLOW PHENOMENON HOW TO#
How to treat "no reflow phenomenon" during primary PCI. How to use thrombo-aspiration catheter to deliver adenosine distally. How to use dedicated CTO devices during non-CTO PCI. Some acute thrombotic lesions may be challenging to cross. This procedure show how to deal wih crossing difficulties during primary PCI as well as management of "no reflow phenomenon". The coronary angiography has shown distal left main stenosis and Proximal LAD thrombotic occlusion. This didactic procedure concerns a patient adressed from neighboring hospital for acute anterior STEMI within the first hour.