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No-reflow phenomenon during percutaneous coronary intervention in a patient with polycythemia vera: A case report
Yudi Her Oktaviono1, Suryo Ardi Hutomo1, Makhyan Jibril Al-Farabi1,2
1Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Airlangga, Soetomo General Hospital, Surabaya, Indonesia.
Insights
Patients with polycythemia vera (PV) experiencing ST-elevation myocardial infarction (STEMI) face high risks during percutaneous coronary intervention (PCI). Advanced techniques like aspiration thrombectomy and thrombolysis are preferred over balloon angioplasty to mitigate complications.
Area of Science:
- Cardiology
- Hematology
Background:
- Acute myocardial infarction (AMI) is a primary cause of mortality in polycythemia vera (PV) patients.
- The efficacy of percutaneous coronary intervention (PCI) techniques in PV patients with AMI remains under-explored.
Rationale:
Acute myocardial infarction is the leading cause of mortality and morbidity in a patient with polycythemia vera (PV). However, the benefit of various percutaneous coronary intervention (PCI) technique on the patient with PV is relatively unexplored.
Patient Concern:
A 46-year-old woman presented to the primary hospital complained about new-onset typical chest pain. Echocardiography examination showed inferior ST-elevation myocardial infarction (STEMIs) and increased cardiac markers. Complete blood count showed elevated hemoglobin, white blood cell, and platelet.
Diagnosis:
Coronary angiography revealed simultaneous total occlusion at proximal right coronary artery (RCA) and also at proximal left anterior descending (LAD) artery. Elevated hemoglobin and hematocrit with JAK2 mutation establish the diagnosis of PV.
Interventions:
We performed multi-vessel primary PCI by using direct stenting in RCA and aspiration thrombectomy in LAD after failed with balloon dilatation and direct stenting method. This procedure resulted in thrombolysis in myocardial infarction (TIMI)-3 flow in both coronary arteries. However, the no-reflow phenomenon occurred in the LAD, followed by ventricular fibrillation. After several attempts of resuscitation, thrombus aspiration, and low-dose intracoronary thrombolysis, the patient was returned to spontaneous circulation. The patient then received dual antiplatelet and cytoreductive therapy.
Outcomes:
The patient clinical condition and laboratory finding were improved, and the patient was discharged on the 7th day after PCI.
Lessons:
Cardiologist should be aware of the no-reflow phenomenon risk in the patient with PV and STEMI. Direct stenting, intracoronary thrombectomy, and thrombolysis are preferable instead of balloon dilatation for PCI technique in this patient.
