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The No-Reflow Phenomenon

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Complications of Percutaneous Coronary Interventions

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Abstract

A 53-year-old man presented to the emergency room with an acute inferolateral myocardial infarction (MI) of 2 hours duration. Urgent coronary angiography showed minor obstructive disease in the left coronary system and a 100% thrombotic occlusion in the mid segment of a large right coronary artery (Figure 8-1A). After one inflation with a 3.0 × 15-mm balloon a severe stenosis was apparent (Figure 8-1B), and the patient became profoundly bradycardic and hypotensive. There was thrombolysis in myocardial infarction (TIMI) grade 1 flow into the distal vessel. Temporary pacing and intravenous fluid administration were initiated with an improvement in hemodynamics. Further balloon inflations were performed across the lesion with minimal improvement in coronary flow. An intravenous abciximab infusion was begun. A 3.5 × 18-mm Medtronic AVE S670 stent was deployed across the occluded segment resulting in TIMI grade 1 epicardial flow. There was a hazy filling defect at the proximal stent edge. An overlapping 4.0 × 9-mm Medtronic AVE S7 stent was deployed to cover this area.

Right coronary angioplasty and stenting complicated by no-reflow in the setting of an acute inferolateral myocardial infarction. Angiographic images are of the right coronary artery in the left anterior oblique projection (A–E), and right anterior oblique projection (F). Refer to the case report in the text for details.

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Authors and Affiliations

  1. Department of Cardiology, Austin Health, Victoria, Australia

    H. M. Omar Farouque MBBS (Hons), PhD. FRACP (Interventional Cardiologist)

  2. Cardiac Catheterization and Coronary Intervention Laboratories, Stanford Interventional Cardiology, Stanford, CA, 94305, USA

    David P. Lee MD (Assistant Professor of Medicine (Cardiovascular), Associate Director)

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  1. H. M. Omar Farouque MBBS (Hons), PhD. FRACP
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  2. David P. Lee MD
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Editors and Affiliations

  1. Section of Cardiology, University of Arizona Sarver Heart Center, Tucson, AZ, 85724, USA

    Samuel M. Butman MD, FACC, FSCAI (Associate Professor of Medicine) (Associate Professor of Medicine)

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Omar Farouque, H.M., Lee, D.P. (2005). The No-Reflow Phenomenon. In: Butman, S.M. (eds) Complications of Percutaneous Coronary Interventions. Springer, New York, NY. https://doi.org/10.1007/978-0-387-29301-1_8

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