Intracoronary bivalirudin for no reflow reversal: a second chance to treat this disorder?
No reflow, defined as failure to restore normal myocardial blood flow despite removal of coronary obstruction, is a not rare complication of ST-elevation acute myocardial infarction. We here describe the case of an old patient experiencing inferior and right ventricle myocardial infarction complicated by cardiogenic shock, anaemia and thrombocytopenia. We managed it with urgent PCI using thrombus aspirator, that determined onset of no reflow, that we successfully managed with intracoronary bivalirudin. We showed how bivalirudin, a drug whose use is increasing in the catheterization laboratories, could be safely used via the intracoronary route to treat no reflow phenomenon due to distal microembolization in a complex patient.
Cortese
Bernardo
B
Interventional Cardiology, Ospedale della Misericordia, Grosseto, Italy. bcortese@gmail.com
Picchi
Andrea
A
Micheli
Andrea
A
Limbruno
Ugo
U
D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage*; D006328:Cardiac Catheterization; D003326:Coronary Circulation / Q000187:drug effects*; D006629:Hirudins / Q000008:administration & dosage*; D006801:Humans; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000628:therapy*; D010446:Peptide Fragments / Q000008:administration & dosage*; D011859:Radiography; D011994:Recombinant Proteins / Q000008:administration & dosage
D000925:Anticoagulants; D006629:Hirudins; D010446:Peptide Fragments; D011994:Recombinant Proteins; C074619:bivalirudin