Management of No-Reflow With Intracoronary Thrombolysis: A Case Report

No-reflow is a recurring phenomenon during coronary angioplasty that consists of the failure to reestablish blood flow after clearing an occluded coronary artery. Several treatments have been proposed for the management of no-reflow, including intracoronary thrombolysis, which has emerged in recent years as one of the means of managing this phenomenon. We report the case of a 68-year-old female patient with a high cardiovascular risk, admitted for the management of non-ST-elevation acute coronary syndrome, who presented a no-reflow phenomenon after angioplasty of the right coronary artery. After the failure of the various means available to reopen the artery, a 30 mg dose of tenecteplase was administered intracoronary with restoration of Thrombolysis in Myocardial Infarction III flow in the angiographic control and good clinical and rhythmic evolution. Fibrinolytic agents remain an effective means in the treatment of acute coronary syndromes with ST-segment elevation. Its use in intracoronary therapy has demonstrated its benefit in restoring flow and improving microcirculation while maintaining a satisfactory safety profile. The use of these agents in the treatment of no-reflow remains an alternative to the usual treatment, such as adenosine and verapamil, and mechanical means, such as thrombo-aspiration, allowing dissolution of the thrombus and reestablishment of the flow. The management of no-reflow phenomena remains difficult, given the varied pathophysiology of this phenomenon and the therapeutic arsenal available for its management. However, intracoronary thrombolysis for the management of no-reflow remains an attractive and interesting alternative with results that remain acceptable, but which need to be approved by studies on larger samples with more details on the dose and the administration methodology.