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Figure 6 A Case in Which a Cluster of Embolic Particles Was Associated With Angiographic No-Reflow

(A) Coronary angiography (left anterior oblique projection) showed the complete occlusion of the proximal portion of the right coronary artery. (B) Thrombolysis In Myocardial Infarction (TIMI) flow grade 3 was achieved after thrombectomy and first and second balloon angioplasty (BA). (E) The average peak velocity detected by the intracoronary Doppler guidewire (DGW) was 6 cm/s. (C) We deployed a 3.0 x 25-mm stent into the culprit lesion. (F) The coronary blood flow velocity waveform showed a large number of HITS within 3 heartbeats after stent-balloon deflation. (G) The coronary blood flow disappeared except for transient antegrade flow in systole 4 beats after balloon deflation. (D) Coronary angiography showed angiographic no-reflow (TIMI flow grade 0), and we performed additional coronary thrombectomy and repeated intracoronary injections of nicorandil and nitroprusside. Ten minutes later, radiocontrast runoff was improved (TIMI flow grade 2). (H and I) Myocardial contrast echocardiography (short-axis view) showed good contrast enhancement (good reflow) at this stage.