Key result
IVUS identifies the underlying cause of no-reflow after primary angioplasty for acute anterior MI.
Case Report (n=1)
This case report highlights the potential utility of intravascular ultrasound in diagnosing the underlying cause of the no-reflow phenomenon during primary angioplasty.
A 73 year old man was admitted with haematemesis and was found to have a pangastritis. Three days later he developed central chest pain, and ECG changes indicated an acute anterior myocardial infarction. In view of his recent haematemesis we performed emergency coronary angiography, which showed proximal occlusion of the left anterior descending (LAD) artery (TIMI 0 flow), with normal circumflex and right coronary arteries. We proceeded to primary percutaneous transluminal coronary angioplasty (PTCA) with a 7 French left 4.5 Judkins guide, a Magnum wire (Schneider UK, Staines, Middlesex, UK), and a 3.5 mm Viva balloon (Boston Scientific Ltd, St Albans, Herts, UK). Unfractionated intravenous heparin 10 000 units was given. The lesion was crossed with Magnum wire and injections at that time showed TIMI 1 flow. The site of occlusion was dilated with the 3.5 mm balloon to 6 then 8 atm with subsequent TIMI 0 flow. Dissection was thought to be the most likely cause of the no-reflow phenomenon and a 3.5 × 34 mm …
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Trevelyan et al. (1999) conducted a case report in Acute anterior myocardial infarction with no-reflow phenomenon (n=1). Intravascular ultrasound was evaluated. Intravascular ultrasound was utilized to diagnose the cause of the no-reflow phenomenon following primary angioplasty in a 73-year-old man with an acute anterior myocardial infarction.
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