No Re-flow Treatment: Do We Need More?

May 17, 2016

The Cath Lab Digest (@CathLabDigest) recently presented a discussion of the no-reflow phenomenon through the case of a 43-year-old male who initially presented with chest pain.  After angioplasty, blood flow in the left anterior descending artery was TIMI-1 and chest pain continued with worsening of electrocardiographic ST-T segment changes.  The Impella CP was inserted for hemodynamic support while nipride and a glycoprotein IIb/IIIa inhibitor were used to improve blood flow.  No-reflow is important because it is associated with poor clinical outcomes and increased mortality and morbidity.  A detailed discussion of other treatments for no-reflow is presented including adenosine, verapamil, thrombus aspiration, laser atherectomy and ventricular unloading.  The clinical significance of ventricular unloading is reviewed and the authors state “left ventricular unloading devices such as the Impella should be considered upfront in patients with elevated left ventricular end-diastolic pressure, low ejection fraction, and early cardiogenic shock, and with persistent symptoms.”

Read the details of this interesting case report entitled “A Case-Based Discussion of No-Reflow Treatment: Do We Need More?”

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