Percutaneous coronary intervention and the no-reflow phenomenon.

Journal article

No-reflow during percutaneous coronary intervention (PCI) is observed most commonly during saphenous vein graft intervention, rotational atherectomy and primary PCI for acute ST-elevation myocardial infarction. The contributions of distal embolization and ischemia/reperfusion injury to the pathogenesis of no-reflow vary in these settings, as does prevention and management. Prevention of no-reflow in these high-risk groups is the best treatment strategy, employing antiplatelet agents, vasodilators and/or mechanical devices to prevent distal embolization. Once mechanical factors are excluded as a cause for reduced epicardial flow, the treatment of established no-reflow is mainly pharmacologic, since the obstruction occurs at the level of the microvasculature. Compared with patients in whom no-reflow is transient, refractory no-reflow is associated with a markedly increased risk of 30-day mortality.

Authors: van Gaal, W; Banning, A

• Journal: Expert review of cardiovascular therapy
• Volume: 5
• Issue: 4
• Pages: 715-731
• Publication date: 2007-07-01
• DOI: 10.1586/14779072.5.4.715
• EISSN: 1744-8344
• ISSN: 1477-9072
• Language: English
• Keywords: Myocardial Reperfusion Injury; Saphenous Vein; Coronary Circulation; Prostheses and Implants; Myocardial Revascularization; Ultrasonography, Interventional; Thrombectomy; Coronary Angiography; Atherectomy, Coronary; Coronary Thrombosis; Myocardial Ischemia; Animals; Myocardial Reperfusion; Humans; Myocardial Infarction; Adenosine; Vasodilator Agents; Regional Blood Flow; Collateral Circulation