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Reviews in Cardiovascular Medicine  2014, Vol. 15 Issue (1): 38-51     DOI: 10.3909/ricm0699
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Prevention and Treatment of No-Reflow Phenomenon by Targeting the Coronary Microcirculation
Attila Feher1, 2, Stephen Y. Chen3, Zsolt Bagi1, 4, Vishal Arora3
1 Vascular Biology Center, Georgia Health Sciences University, Augusta, GA
2 Department of Medicine, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY
3 Division of Cardiovascular Medicine, Georgia Health Sciences University, Augusta, GA
4 Department of Pharmacology, University of Oxford, Oxford, United Kingdom
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Abstract:
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.
Key words:  No-reflow      Coronary microcirculation      Microvascular obstruction     
Published:  30 March 2014     

Cite this article: 

Attila Feher, Stephen Y. Chen, Zsolt Bagi, Vishal Arora. Prevention and Treatment of No-Reflow Phenomenon by Targeting the Coronary Microcirculation. Reviews in Cardiovascular Medicine, 2014, 15(1): 38-51.

URL: 

https://rcm.imrpress.com/EN/10.3909/ricm0699     OR     https://rcm.imrpress.com/EN/Y2014/V15/I1/38

[1] Bu-Chun Zhang, Cheng Wang, Zhi-Wen Zhou, Yan-Feng Ma, Wen-Hua Li, Dong-Ye Li. Coronary Plaque Characteristics Affect No-Reflow During Primary Percutaneous Coronary Intervention: A Pooled Analysis of 14 Observational Studies Using Intravascular Ultrasound[J]. Reviews in Cardiovascular Medicine, 2015, 16(3): 200-213.
[2] Jay Ambrose. Successful Treatment of a Distal Saphenous Vein Graft Lesion Using the Proxis™ Embolic Protection System[J]. Reviews in Cardiovascular Medicine, 2007, 8(3): 182-184.
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