| Summary: | HOW WOULD I APPROACH IT? This is the case of a 57-year-old man with a past medical history of ischemic heart disease treated percutaneously years ago who was admitted with signs of non-ST-elevation acute coronary syndrome and inferior wall hypokinesis on the echocardiogram. The coronary angiography performed 24 hours after admission revealed the presence of restenosis in a stent implanted into the mid left anterior descending coronary artery and severe stenosis of distal right coronary artery. The angiographic imaging suggested the presence of 1 intraluminal thrombus spreading towards the ostium of the posterior descending coronary artery. The right coronary artery underwent immediate percutaneous treatment with balloon predilatation, which immediately triggered the appearance of the no-reflow phenomenon (NRP). NRP is defined as a reduced coronary flow after the angioplasty for the lack of a mechanical obstruction of the epicardial coronary artery. Although its incidence rate has somehow dropped over the last few years with the use of more powerful antiplatelet drugs and early approach of coronary syndromes, the therapeutic management of this entity is still challenging for the lack of standard therapies. From the pathophysiological point of view, the NRP has been associated with an occlusion of coronary microcirculation of multifactorial origin including...
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