Int J Angiol
DOI: 10.1055/s-0043-1764475
Case Report

How an Aggressive Treatment of No-reflow Phenomenon in Primary Percutaneous Coronary Intervention with High Thrombus Burden can Achieve a Grade III TIMI-flow: A Case Report

1   Department of Cardiology and Vascular Medicine, Faculty of Medicine University of Padjadjaran, Bandung, Indonesia
1   Department of Cardiology and Vascular Medicine, Faculty of Medicine University of Padjadjaran, Bandung, Indonesia
2   R. Syamsudin SH Regional Public Hospital, Sukabumi, West Java, Indonesia
Aron Husink
3   Department of Cardiology and Vascular Medicine, Elang Medika Corpora Tangerang Hospital, Tangerang, Indonesia
Teddy Arnold Sihite
1   Department of Cardiology and Vascular Medicine, Faculty of Medicine University of Padjadjaran, Bandung, Indonesia
› Author Affiliations
Funding None.


Introduction The management of the no-reflow phenomenon is still being debated by experts as there is no specific algorithm, limited recommended drug choices, and insufficient data regarding the combination of drugs in currently available guidelines. Thus, in this case report, we would like to propose a new combination of drugs as an alternative to the recommended drugs of choice in the treatment of no-reflow phenomenon.

Case Presentation A 41-year-old man arrived at the emergency department complaining of chest pain 30 minutes prior to arrival. However, the patient was later diagnosed with extensive anterior ST-elevation myocardial infarction, KILLIP classification I, which was caused by the entire blockage of the proximal left anterior descending coronary artery. Angiography was conducted after stent placement during the main percutaneous coronary intervention and revealed grade I thrombolysis in myocardial infarction (TIMI)-flow with no coronary artery blockage. We then used an intracoronary approach to give nitroglycerin, heparin, and eptifibatide. The findings of posttreatment angiography revealed an improvement in coronary blood flow with a grade II TIMI flow. Furthermore, intravenous injection of eptifibatide and morphine effectively restored perfusion to a grade III TIMI flow.

Conclusion Aggressive and precise treatment with a drug of choice is required to counteract the no-reflow phenomenon. Presently, only a limited range of first-line medications are available to treat this condition. Not only that, but several of the prescribed medications are not easily accessible, especially in developing countries. Therefore, we offer a novel combination medicaments consisting of nitroglycerin, heparin, and glycoprotein IIb/IIIa inhibitor as an alternative treatment of the no-reflow phenomenon.

Authors' Contributions

J.W.M., I.C.S.P., and A.H. conceived and design the study. J.W.M., I.C.S.P., and W.K. performed literature research, acquired the data, and drafting the manuscript. J.W.M., A.H., and T.A.S. provided revision, supervision, and final approval of the manuscript. All authors approved the final manuscript.

Publication History

Article published online:
10 April 2023

© 2023. International College of Angiology. This article is published by Thieme.

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