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Review
. 2012 Aug;8(3):209-14.
doi: 10.2174/157340312803217148.

Treating and preventing no reflow in the cardiac catheterization laboratory

Ryan Berg  1 , Cyrus Buhari
Affiliations
Review

Treating and preventing no reflow in the cardiac catheterization laboratory

Ryan Berg et al. Curr Cardiol Rev. 2012 Aug.

Abstract

The no reflow phenomenon can happen during elective or primary percutaneous coronary intervention. This phenomenon is thought to be a complex process involving multiple factors that eventually lead to microvascular obstruction and endothelial disruption. Key pathogenic components include distal atherothrombotic embolization, ischemic injury, reperfusion injury, and susceptibility of coronary microcirculation to injury. Thus, pharmacologic and mechanical strategies to prevent and treat no reflow target these mechanisms. Specifically, pharmacologic therapy consisting of vasodilators and antiplatelet agents have shown benefit in the treatment of no-reflow and mechanical therapies such as distal protection and aspiration thrombectomy have also shown benefit.

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Figures

Fig. (1)
Fig. (1)
Myocardial targets for pharmacological therapies to prevent no-reflow. The inset depicts a myocardial cell and its subcellular structures involved in cardioprotective pathways. Adapted with permission from Jaffe R, Dick A, and Strauss B. Prevention and Treatment of Microvascular Obstruction-Related Myocardial Injury and Coronary No-Reflow Following Percutaneous Coronary Intervention. A Systematic Approach. J Am Coll Cardiol Intv 2010;3:695-704.
Fig. (2)
Fig. (2)
Mechanical strategies to prevent no-reflow. The inset depicts aspirated thrombus. Adapted with permission from Jaffe R, Dick A, and Strauss B. Prevention and Treatment of Microvascular Obstruction-Related Myocardial Injury and Coronary No-Reflow Following Percutaneous Coronary Intervention. A Systematic Approach. J Am Coll Cardiol Intv 2010; 3: 695-704.
Fig. (3)
Fig. (3)
Algorithm for prevention and treatment of no-reflow. PCI=Percutaneous Coronary Intervention, SVG=Saphenous Vein Grafts, IC=Intracoronary
See this image and copyright information in PMC

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