Complication: No Reflow

Chapter
Part of the Clinical Cases in Interventional Cardiology book series (CCIC)

Abstract

A 72-year-old Chinese male with background cardiovascular risk factors of hypertension and diabetes mellitus underwent an elective coronary angiogram. He had a significant medical history of end stage renal failure on hemodialysis, paroxysmal atrial fibrillation on warfarin, anemia of chronic disease, and peptic ulcer disease. He was admitted for a recent creation of arteriovenous fistula which was complicated by a type 2 myocardial infarct with hypotension during dialysis. A transthoracic echocardiogram done showed that the left ventricular ejection fraction was still preserved at 55%. There were infero-septal wall motion abnormalities seen. A stress myocardial perfusion study was positive for ischemia over anteroseptal regions.

Supplementary material

Video 21.1

The baseline coronary angiogram showed tight discrete calcified lesions in the proximal-mid left anterior descending artery (MPG 595 kb)

Video 21.2

The baseline coronary angiogram showed tight discrete calcified lesions in the proximal-mid left anterior descending artery (MPG 955 kb)

Video 21.3

Lesion preparation using the AngioSculpt scoring balloon was unsuccessful with rupture of the balloon (MPG 1557 kb)

Video 21.4

Rotational atherectomy of the vessel with a 1.5 mm burr at 150,000 RPM (MPG 1558 kb)

Video 21.5

No reflow noted after the rotational atherectomy (MPG 700 kb)

Video 21.6

Improved flow after balloon angioplasty (MPG 1195 kb)

Video 21.7

Further improvement of coronary flow after intracoronary adenosine, verapamil, and glyceryl trinitrate (MPG 704 kb)

Video 21.8

Final angiogram showing an excellent angiographic result (MPG 1331 kb)

Video 21.9

Final angiogram showing an excellent angiographic result (MPG 944 kb)

Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  1. 1.Department of CardiologyNational Heart Centre SingaporeSingaporeSingapore

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