Managing no-reflow during percutaneous coronary intervention. (August 2012)

• Record Type: Journal Article
• Authors: Derntl, Michael; Weidinger, Franz
• Is Part Of: Interventional cardiology. Volume 4:Number 4(2012)
• Page Start: 461
• Page End: 472
• Publication Date: 2012-08
• Subjects: acute myocardial infarction -- embolization -- microcirculation -- percutaneous coronary intervention -- thrombectomy -- vasoconstriction; Cardiology -- Periodicals; Coronary heart disease -- Treatment -- Periodicals; 616.1205
• DOI: 10.2217/ica.12.31
• Languages: English
• ISSNs: 1755-5310

Abstract

Visible impairment of epicardial coronary flow associated with ischemia may occur during percutaneous coronary intervention (PCI). This so called no-reflow phenomenon is found despite any evidence for distal embolic cutoff, obstruction or vessel dissection. It occurs in patients who undergo PCI, typically of a lesion responsible for recent myocardial infarction, or treatment of a saphenous vein graft. Various mechanisms leading to microvascular obstruction induce no-reflow. No-reflow has a strong negative impact on clinical outcome. Administration of adenosine, a calcium-channel blocker, or nitroprusside is appropriate to treat PCI-related no-reflow that occurs during primary or elective PCI. In the setting of acute myocardial infarction, evidence for a beneficial effect on no-reflow also exists for abciximab and nicorandil. Thrombectomy and/or embolic protection devices should be used for the prevention of no-reflow in the setting of high thrombus burden and during saphenous vein graft intervention.