Prevention and treatment of no-reflow phenomenon by targeting the coronary microcirculation.
The coronary no-reflow phenomenon refers to the post-percutaneous coronary intervention (PCI) state in which, despite successful revascularization of the epicardial conduit coronary arteries, substantial regions of the myocardium do not receive adequate perfusion. In most cases, the underlying mechanism can be attributed to alterations in the microvascular circulation caused by factors intrinsic or extrinsic to the coronary microcirculation. Because the no-reflow phenomenon is associated with poor clinical outcomes, it is of great importantance to identify and apply effective strategies for reducing post-PCI morbidity and mortality. Successful prevention strategies aim to ad dress increased vasoreactivity, intravascular platelet aggregation, microvascular inflammation, and down-stream plaque particle embolization. This review provides an updated overview on the pathomechanism of no-reflow and the current available prevention strategies from the perspective of coronary microcirculation. Although large randomized clinical trials have not yet identified any effective treatment, studying the coronary microcirculation may reveal new therapeutic targets for successful amelioration of the adverse clinical consequences from no-reflow phenomenon.
Vascular Biology Center, Georgia Health Sciences University, Augusta, GA; Department of Medicine, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY.
Attila
A
Feher
Division of Cardiovascular Medicine, Georgia Health Sciences University, Augusta, GA.
Stephen Y
SY
Chen
Vascular Biology Center, Georgia Health Sciences University, Augusta, GA; Department of Pharmacology, University of Oxford, Oxford, United Kingdom.
Zsolt
Z
Bagi
Division of Cardiovascular Medicine, Georgia Health Sciences University, Augusta, GA.
Vishal
V
Arora
D000818:Animals; D003324:Coronary Artery Disease / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D003326:Coronary Circulation; D006801:Humans; D008833:Microcirculation; D054318:No-Reflow Phenomenon / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000517:prevention & control / Q000628:therapy*; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects* / Q000401:mortality; D012307:Risk Factors; D016896:Treatment Outcome