CASE20210828_004

A Multipurpose Cocktail for No Reflow after Stenting

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Presenter

Amjad Ali

Authors

1

Affiliation

, India1
Complications - Complications

A Multipurpose Cocktail for No Reflow after Stenting

1

, India1

Clinical Information

Patient initials or Identifier Number

MM

Relevant Clinical History and Physical Exam

A 68-year-old gentleman admitted with acute anterior wall myocardial infarction. His vitals were stable and an echocardiogram revealed hypokinesia of the left anteriordescending artery (LAD) territory with an ejection fraction of 40%. We took this patient for primary percutaneous coronary intervention (PCI).

Relevant Test Results Prior to Catheterization

hemoglobin - 9g/dleGFR- 38 mL/min/1.73m2

Relevant Catheterization Findings

His coronary angiogram (CAG) revealed triple vessel coronary artery disease, LAD showed diffuse long segment 90-95% stenosis (culprit vessel).

Interventional Management

Procedural Step

Primary PCI to LAD was done by placing a 3x48 drug-elutingstent across the lesion. After post dilatation of stent CAG showed no-reflow in LAD artery and patient started complaining of severe chest pain withhypotension. Intracoronary cocktail comprising of 100 micrograms of nitroglycerine,1 milligram of diltiazem, 2 milligrams of nicorandil, abciximab along with fewdrops of diluted adrenaline was administered via a thrombus aspiration catheterinside the stented segment of LAD. Following which LAD showed good TIMI IIIflow with complete resolution of chest pain and ST-segment elevation in the monitor. 

Case Summary

Intracoronary nitroglycerine dilates the epicardial coronaryarteries whereas nicorandil and diltiazem functions to dilate themicrocirculation. Intracoronary abciximab has role in dissolving distalembolization of thrombus and finally very low dose of adrenaline leads toincrease cardiac contractility and prevention of hypotension. So this cocktailwith multiple drugs acts at different etiologies of no reflow and is moreeffective rather than using these drugs separately. This case also showed theimportance of giving the aforesaid cocktail via thrombosuction catheter insidethe vessel rather than administrating it through a guiding catheter.