title: Ultrasound attenuated coronary plaque as a risk factor for slow flow or no-reflow during percutaneous coronary intervention: a case report.
abstract: Slow flow or no-reflow is a serious complication during percutaneous coronary intervention (PCI), but little is known about the risk factors. A 64-year-old man underwent coronary angiography and PCI for stable angina. Pre-interventional intravascular ultrasound demonstrated an ultrasound attenuated coronary plaque, as a long eccentric bulky plaque with a marked decrease of the back echo without calcification. Since the lesion was highly eccentric in the large left anterior descending artery, directional coronary atherectomy (DCA) and subsequent stent implantation were planned. Serious no-reflow occurred after DCA. The DCA specimen suggested that the lipid-laden atheromatous gruel could attenuate the ultrasound reflection and cause distal embolization, resulting in no-reflow during PCI. The presence of ultrasound attenuated coronary plaque is a predictor of slow flow or no-reflow in PCI, indicating that distal protection devices may be required during the procedure.
authors: Department of Cardiology, Osaka City General Hospital, Miyakojima-hondori, Miyakojima-ku, Osaka.
authors: Shinichi
authors: S
authors: Furuichi
authors: Akira
authors: A
authors: Itoh
authors: Hatsue
authors: H
authors: Ishibashi-Ueda
authors: Teruo
authors: T
authors: Noguchi
authors: Masami
authors: M
authors: Miyawaki
authors: Kei
authors: K
authors: Nomura
authors: Yukio
authors: Y
authors: Arita
authors: Masato
authors: M
authors: Otsuka
authors: Takashi
authors: T
authors: Shindo
mesh_terms: D000787:Angina Pectoris / Q000000981:diagnostic imaging / Q000628:therapy*; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects*; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000503:physiopathology; D003326:Coronary Circulation; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D018084:Ultrasonography, Interventional