No-Reflow Phenomenon

Chapter

Abstract

Despite outstanding achievements in the last decades in the treatment of coronary artery disease and especially acute myocardial infarction, mortality and morbidity on follow-up have remained high. High morbidity is partly a result of the no-reflow phenomenon, which is the inability to reperfuse a previously ischemic region despite achieved patency of the epicardial coronary artery. The pathogenesis of no-reflow is complex and multifactorial, and the importance of individual components varies among patients. The three main factors responsible for the lack of reperfusion include ischemic damage, reperfusion injury, and distal embolization. The incidence of no-reflow varies according to the method of assessment and clinical setting, with ST-segment elevation acute myocardial infarction patients having the highest incidence of no-reflow. In STEMI patients, 5% incidence of no-reflow has been reported when assessed using angiographic thrombolysis in myocardial infarction (TIMI) flow, but up to 50% and even more when assessed by cardiac magnetic resonance. The best treatment of no-reflow remains prevention. Based on the underlying pathogenetic mechanisms, several different strategies have been recommended; however, no standard treatment is available at present and treatment failure is frequent.

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Authors and Affiliations

  1. 1.Valduce HospitalComoItaly

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