Successful management of the no-reflow syndome after venous graft stenting.
The no-reflow phenomenon is often found in venous grafts and every effort to prevent it is worthwhile. We performed an angioplasty on a venous graft in a patient with a NSTE acute coronary syndrome with previous inferior myocardial infarction (1996) and CABG (3 venous grafts ), respectively. The native coronary vessels had significant lesions: 70% left main stenosis, distal circumflex artery occlusion, LAD occlusion after the first diagonal branch and proximal occlusion of the RCA. All of the venous grafts,with the exception of the circumflex, were patent. The latter showed subocclusion and slow flow. This was the culprit lesion for the unstable syndrome. After stenting it, no residual stenosis appeared, but severe no-reflow ensued. The no-reflow phenomenon disappeared after intracoronary eptifibatide infusion and aspiration of the slugging contrast from the vein. Clinically, the patient had no chest pain and his ECG changes normalized.
Iancu
Adrian C
AC
Cluj Napoca Heart Institute, University of Medicine, , Cluj, Romania.
Lazar
Alexandra
A
D000368:Aged; D001807:Blood Vessel Prosthesis / Q000009:adverse effects*; D000077542:Eptifibatide; D006083:Graft Occlusion, Vascular / Q000628:therapy*; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000601:surgery*; D010455:Peptides / Q000627:therapeutic use; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011182:Postoperative Care; D015607:Stents
D010455:Peptides; D010975:Platelet Aggregation Inhibitors; D000077542:Eptifibatide