CLINICAL CASE OF NO-REFLOW PHENOMENON IN PRIMARY PERCUTANEOUS CORONARY INTERVENTION

No-reflow phenomenon is one of complications of the primary percutaneous coronary intervention. The basis of this pathology is lack of adequate reperfusion in myocardial tissues after recanalization of the infarct-related coronary vessel. The incidence of no-reflow is 3-4%, and in 30-40% of these cases the phenomenon occurs after urgent revascularization in myocardial infarction. The main pathogenetic factors in re-low are ischemic and reperfusion damages, trauma of the endothelium and distal atherothrombotic embolization. In development of no-reflow phenomenon a role is played by local and systemic risk factors. The diagnostics of no-reflow phenomenon relies on coronary angiography with evaluation of the extent of recovery of the blood flow and perfusion of the myocardial tissues, and also on electrocardiography, contrast echocardiography and magnetic-resonance tomography with contrast agent. No-reflow phenomenon may be prevented by medicamentous preparation to percutaneous intervention, by use of methods of removal of thrombi, and by direct stenting without preliminary inflation of the balloon in combination with preceding aspiration of thrombus. Treatment consists in use of embolic protection devices, and in intracoronary introduction of blockers of glycoprotein IIB/IIIA receptors of platelets. In the article a clinical case of no-reflow phenomenon is described in a male patient of 71 years old that happenedin percutaneous coronary intervention in a repeated myocardial infarction. After revascularization the blood flow in the myocardial tissues failed torecover, that is, no-reflow phenomenon developed.Here, the condition of the patient sharply worsened, he lost consciousness. Resuscitation measures were carried out, intracoronary introduction of heparin, which resulted in complete recovery of the lumen of the artery. The patient was prescribed double antiplatelet therapy, inhibitor of angiotensinconverting enzyme, beta-blocker, statin. With the underlying treatment, pain in the chest did not recur. The patient was discharged from hospital in the satisfactory condition for observation by a cardiologist of his place of residence.