Table 17.1 No-reflow aetiology, prevention and treatment
Aetiology | Prevention | Treatment | |
|---|---|---|---|
Myocardial infarction | Thrombotic | Optimal anticoagulation Consider thrombectomy or balloon inflation to restore TIMI III flow with minimal invasive strategy | Anti-GPIIb/IIIa Intracoronary calcium inhibitors Adenosine |
Microvascular vasospasm | Nitrates | ||
Rotablator | Atherothrombotic embolization Platelet activation Vasospasm | Optimal anticoagulation Nitrates Maintained stable haemodynamic (temporary pacemaker/atropine in case of severe bradycardia) Flush infusion with nitrates and or calcium inhibitors | Intracoronary calcium inhibitors Adenosine |
Venous graft | Atherothrombotic | Distal protection Adenosine intra graft Nicardipine | Intragraft calcium inhibitors Adenosine |
Iatrogenic | Thrombotic | Optimal anticoagulation with ACT monitoring | Heparin anti-GPIIb/IIIa Consider balloon inflation or thrombectomy |