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Prevention of the no-refl ow phenomenon in emergency coronary artery stenting in a patient with ST-segment elevation myocardial infarction (case report)

Abstract

Approaches to myocardial revascularization in patients with acute ST-segment elevation myocardial infarction remain controversial, both from the point of view of disaggregant therapy and from endovascular approaches to restoring the lumen of the affected vessels.

We herein present the result of treating a 64-year-old male patient admitted to the Regional Vascular Center of the Aleksandrovskaya Hospital with a preliminary diagnosis of “Acute coronary syndrome with ST segment elevation. Acute heart failure class IV according to Killip”.

The findings of angiography revealed acute occlusions of the proximal segments of the right coronary artery and the anterior interventricular branch of the left coronary artery. Given a combination of prognostically unfavorable factors, a decision was made intraoperatively on preventive administration of eptifi batide, followed by manual thromboaspiration and implantation of stents without predilation, which, in our opinion, had a beneficial effect on the further course of the disease. This clinical case demonstrates the importance of risk stratification and an individual approach to myocardial revascularization in patients with the pathology concerned.

In addition, this clinical example underlines an important role of preventive administration of IIb/IIIa glycoprotein receptor blockers and thrombus aspiration in relation to the development of reperfusion complications and the no-refl ow phenomenon in a patient with an extremely high risk of their occurrence.

Funding. The study had no financial support.

Conflict of interest. The authors declare no conflicts of interest.

Authors’ contribution. Study conception and design – Shishkevich A.N., Bessonov E.Yu.; data collection and handling – Bessonov E.Yu., Bogomolov A.N., Dyuzhilov A.V., Kachesov E.Yu.; draft manuscript preparation – Bessonov E.Yu., Bogomolov A.N., Mikhailov S.S., Fedorov A.S.

For citation: Bessonov E.Yu., Bogomolov A.N., Dyuzhilov A.V., Shishkevich A.N., Kachesov E.Yu., Mikhailov S.S., Fedorov A.S. Prevention of the no-reflow phenomenon in emergency coronary artery stenting in a patient with ST-segment elevation myocardial infarction (case report). Angiology and Vascular Surgery. Journal named after Academician A.V. Pokrovsky. 2024; 30 (2): 117–23. DOI: https://doi.org/10.33029/1027-6661-2024-30-2-117-123

Keywords: ST-segment elevation myocardial infarction; no-reflow phenomenon; myocardial reperfusion syndrome; percutaneous coronary intervention

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Akchurin Renat Suleymanovich

Doctor of Medical Sciences, Professor, Academician of the Russian Academy of Sciences, Deputy General Director for Surgery, Head of the Department of Cardiovascular Surgery, National Medical Research Center for Cardiology named after Academician E.I. Chazov, President of the Russian Society of Angiologists and Vascular Surgeons

In accordance with the decision of the Presidium of the Russian Society of Angiologists and Vascular Surgeons, the journal "Angiology and Vascular Surgery" will be named after Academician A.V. Pokrovsky starting from No. 2/2022.