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CASE20191018_004
| CORONARY - Acute Coronary Syndromes (STEMI, NSTE-ACS) | |
| No Re-Flow Phenomenon in Primary PCI STEMI: What Can We Do? | |
| Chyntia Monica Gultom1, Yahya Berkahanto Juwana2, Herawati Isnanijah1, Rido Sukaton3 | |
| Pasar Rebo General Hospital Jakarta, Indonesia1, Rs Pondok Indah, Indonesia2, RSUD Pasar Rebo, Indonesia3, | |
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[Clinical Information]
- Patient initials or identifier number:
DDK
-Relevant clinical history and physical exam:
A 35-year-old male patient with a chief complaint of typical chest pain of infarction with 5 hours of onset. He was a smoker for years and had a history of hypertension and dyslipidemia. No physical examination abnormalities were found.
-Relevant test results prior to catheterization:
A blood test revealed an increased cardiac enzyme. ECG shows an elevated ST segment in anterior.
 - Relevant catheterization findings:
TIMI 3 flow in left anterior descending coronary artery with 50 - 60% stenosis in osteal part and 70% stenosis in mid part. Non significant stenosis in left circumflex coronary artery.
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[Interventional Management]
- Procedural step:
The PCI to LAD lesion was done using radial approach. Wiring with BMW until distal LAD was done, but could not passed through the lesion. Then wiring with Pilot 50 0.014" 19 cm until distal LAD. Dilatation was performed with 2.75 balloon, but did not achieved any flow. Another dilatation was performed with larger balloon 3.0, we only achieved TIMI 1 flow. After a while, the procedure was stopped. Radial 3000 IU of heparin, 5000 IU of heparin intracoronary pre PCI procedure, 5000 IU of heparin intracoronary during PCI procedure and 300 mg of nitroglycerin were given with stable hemodynamic. CAG evaluation was done after 1 month of discharge. CAG was revealed there is TIMI 3 flow in LAD with 50 - 60 % stenosis in osteal, 70% long stenosis in mid part.
 Philips DICOM Viewer 2019-10-29 19-09-06.mov Philips DICOM Viewer 2019-10-29 19-05-59.mov Philips DICOM Viewer 2019-10-29 19-05-02.mov- Case Summary:
No re-flow phenomenon had a poor prognosis in STEMI, but balloon angioplasty alone and optimal medication are benefit to restore no-reflow. Due to limited medication, nitroglycerin, clopidogrel and heparin only can be an alternative to treat no re-flow.
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