The no‐reflow phenomenon in coronary arteries

Abstract

Summary. No reflow occurs when there is inadequate myocardial perfusion of a given segment of the coronary circulation without evidence of epicardial vessel obstruction. It is a rare but clinically significant condition associated with myocardial infarction and coronary interventions. Diagnosis is usually based on clinical signs of myocardial ischemia (symptoms and/or ECG changes) combined with coronary angiography. Management can be difficult and primarily consists of intracoronary administration of vasodilators. One interesting etiology is thromboembolism and this has become the focus for new potential treatments, including distal embolic protection devices.

Role of pre-infarction angina and inflammatory status in the extent of microvascular obstruction detected by MRI in myocardial infarction patients treated by PCI

“…For statistical analysis, the cohort was divided in two subsets according to the MRI score of microvascular obstruction: low score (0-1) and high score (2)(3). Data are expressed as mean ± SD.…”

“…It is widely recognized that, although mechanical or pharmacological reperfusion is essential for the survival of ischemic tissues, reperfusion can promote a variety of adverse events in cardiac myocytes and coronary microvasculature [1,2]. Previous studies using contrast echography, technetium scintigraphy, blush angiographic score, and magnetic resonance imaging (MRI) demonstrated that despite recanalization of the infarct-related artery, up to 30% of patients undergoing PCI lack efficient myocardial International Journal of Cardiology 121 (2007) 139 -147 www.elsevier.com/locate/ijcard reperfusion [3][4][5][6].…”

Use and impact of thrombectomy in primary percutaneous coronary intervention for acute myocardial infarction with persistent ST-segment elevation: results of the prospective ALKK PCI-registry

“…Currently, primary percutaneous coronary intervention (PCI) is the reperfusion strategy of choice in patients with STEMI [1]. However, while reopening of the epicardial vessel is usually successful, there is inadequate myocardial reperfusion in 10-40 % of patients [2][3][4][5][6]. This so-called no-reflow (or slow-reflow) phenomenon is defined by post-procedural ''thrombolysis in myocardial infarction'' (TIMI) flow \3 or myocardial blush grade 0 or 1 in the case of a TIMI 3 flow or STsegment resolution \70 % within 4 h of revascularization [7].…”

Relationship between Retrograde Coronary Blood Flow and the Extent of No-Reflow and Infarct Size in a Porcine Ischemia–Reperfusion Model

“…Several lines of evidence suggest that platelet and thrombus embolization, associated with primary coronary intervention, constitute a major cause of no-reflow in humans, and this can impact noreflow independently of the size of the area at risk [2,24]. In this setting, prompt recognition of unsuccessful tissue reperfusion becomes of paramount importance.…”