title: Intracoronary bivalirudin for no reflow reversal: a second chance to treat this disorder?
abstract: 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.
authors.affiliation: Interventional Cardiology, Ospedale della Misericordia, Grosseto, Italy. bcortese@gmail.com
authors.forename: Bernardo
authors.initials: B
authors.lastname: Cortese
authors.forename: Andrea
authors.initials: A
authors.lastname: Picchi
authors.forename: Andrea
authors.initials: A
authors.lastname: Micheli
authors.forename: Ugo
authors.initials: U
authors.lastname: Limbruno
mesh_terms: 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
chemical_list: D000925:Anticoagulants; D006629:Hirudins; D010446:Peptide Fragments; D011994:Recombinant Proteins; C074619:bivalirudin