Percutaneous coronary intervention and the no-reflow phenomenon.
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.
van Gaal
William J
WJ
Department of Cardiology, Level 2, John Radcliffe Hospital, Oxford, OX3 9DU, UK. bill.vangaal@conted.ox.ac.uk
Banning
Adrian P
AP
D000241:Adenosine / Q000627:therapeutic use; D000818:Animals; D017225:Atherectomy, Coronary; D003097:Collateral Circulation; D017023:Coronary Angiography; D003326:Coronary Circulation / Q000502:physiology; D003328:Coronary Thrombosis / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D009203:Myocardial Infarction / Q000503:physiopathology / Q000628:therapy; D017202:Myocardial Ischemia / Q000503:physiopathology* / Q000628:therapy*; D015425:Myocardial Reperfusion; D015428:Myocardial Reperfusion Injury / Q000503:physiopathology; D009204:Myocardial Revascularization; D019736:Prostheses and Implants; D012039:Regional Blood Flow; D012501:Saphenous Vein / Q000637:transplantation; D017131:Thrombectomy / Q000295:instrumentation; D018084:Ultrasonography, Interventional; D014665:Vasodilator Agents / Q000627:therapeutic use
D014665:Vasodilator Agents; D000241:Adenosine