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Textbook of Catheter-Based Cardiovascular Interventions pp 1007–1015Cite as

No-Reflow Phenomenon

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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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References

  1. Hamm CW, Bassand JP, Agewall S, Bax J, Boersma E, Bueno H, Caso P, Dudek D, Gielen S, Huber K, Ohman M, Petrie MC, Sonntag F, Uva MS, Storey RF, Wijns W, Zahger D, Guidelines EC for P, Bax JJ, Auricchio A, Baumgartner H, Ceconi C, Dean V, Deaton C, Fagard R, Funck-Brentano C, Hasdai D, Hoes A, Knuuti J, Kolh P, et al. ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: The Task Force for the management of acute coronary syndromes (ACS) in patients presenting without persistent ST-segment elevation. Eur Heart J. 2011;32:2999–3054.

    Article  PubMed  Google Scholar 

  2. Durante A, Latib A, Pizzetti G, Colombo A, Camici PG. A high-volume single center experience of no-reflow post-percutaneous coronary intervention. G Ital Cardiol. 2014;15:110–5.

    Google Scholar 

  3. Rezkalla SH, Kloner RA. Coronary no-reflow phenomenon: from the experimental laboratory to the cardiac catheterization laboratory. Catheter Cardiovasc Interv. 2008;72:950–7.

    Article  PubMed  Google Scholar 

  4. Durante A, Camici PG. Novel insights into an ‘old’ phenomenon: the no reflow. Int J Cardiol. 2015;187:273–80.

    Article  PubMed  Google Scholar 

  5. Galiuto L, Lombardo A, Maseri A, Santoro L, Porto I, Cianflone D, Rebuzzi AG, Crea F. Temporal evolution and functional outcome of no reflow: sustained and spontaneously reversible patterns following successful coronary recanalisation. Heart. 2003;89:731–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Galiuto L, Lombardo A, Maseri A, Santoro L, Porto I, Cianflone D, Rebuzzi AG, Crea F. Temporal evolution and functional outcome of no reflow: sustained and spontaneously reversible patterns following successful coronary recanalisation. Heart [Internet]. 2003 [cited 2016 Nov 7]; 89:731–7. Available from: http://www.ncbi.nlm.nih.gov/pubmed/12807843.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Niccoli G, Cosentino N, Lombardo A, Sgueglia GA, Spaziani C, Fracassi F, Cataneo L, Minelli S, Burzotta F, Maria Leone A, Porto I, Trani C, Crea F. Angiographic patterns of myocardial reperfusion after primary angioplasty and ventricular remodeling. Coron Artery Dis [Internet]. 2011 [cited 2016 Nov 7]; 22(7):507–14. doi: https://doi.org/10.1097/MCA.0b013e32834a37ae.

  8. Krug A, de Du Mesnil R, Korb G. Blood supply of the myocardium after temporary coronary occlusion. Circ Res. 1966;19:57–62.

    Article  CAS  PubMed  Google Scholar 

  9. Majno G, Ames A, Chaing J, Wright RL. No reflow after cerebral ischemia. Lancet. 1967;290:569–70.

    Article  Google Scholar 

  10. Kloner RA, Ganote CE, Jenning RB. The ‘no-reflow’ phenomenon after temporary coronary occlusion in the dog. J Clin Invest. 1974;54:1496–508.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Reimer KA, Lowe JE, Rasmussen MM, Jennings RB. The wavefront phenomenon of ischemic cell death: 1. Myocardial infarct size vs duration of coronary occlusion in dogs. Circulation. 1977;56:786–94.

    Article  CAS  PubMed  Google Scholar 

  12. Braunwald E. Myocardial reperfusion, limitation of infarct size, reduction of left ventricular dysfunction, and improved survival. Should the paradigm be expanded? Circulation. 1989;79:441–4.

    Article  CAS  PubMed  Google Scholar 

  13. Roe MT, Ohman EM, Maas AC, Christenson RH, Mahaffey KW, Granger CB, Harrington RA, Califf RM, Krucoff MW. Shifting the open-artery hypothesis downstream: the quest for optimal reperfusion. J Am Coll Cardiol. 2001;37:9–18.

    Article  CAS  PubMed  Google Scholar 

  14. Tranum-Jensen J, Janse MJ, Fiolet WT, Krieger WJ, D’Alnoncourt CN, Durrer D. Tissue osmolality, cell swelling, and reperfusion in acute regional myocardial ischemia in the isolated porcine. Circ Res. 1981;49:364–81.

    Article  CAS  PubMed  Google Scholar 

  15. Kalogeris T, Baines CP, Krenz M, Korthuis RJ. Cell biology of ischemia/reperfusion injury. Int Rev Cell Mol Biol. 2012;298:229–317.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Reffelmann T, Kloner RA. The no-reflow phenomenon: a basic mechanism of myocardial ischemia and reperfusion. Basic Res Cardiol. 2006;101:359–72.

    Article  PubMed  Google Scholar 

  17. Yellon DM, Hausenloy DJ. Myocardial reperfusion injury. N Engl J Med. 2007;357:1121–35.

    Article  CAS  PubMed  Google Scholar 

  18. Engler RL, Schmid-Schönbein GW, Pavelec RS. Leukocyte capillary plugging in myocardial ischemia and reperfusion in the dog. Am J Pathol. 1983;111:98–111.

    PubMed  PubMed Central  CAS  Google Scholar 

  19. Ambrosio G, Tritto I. Reperfusion injury: experimental evidence and clinical implications. Am Heart J. 1999;138:S69–75.

    Article  CAS  PubMed  Google Scholar 

  20. Galve E, Garcia-Del-Castillo H, Evangelista A, Batlle J, Permanyer-Miralda G, Soler-Soler J. Pericardial effusion in the course of myocardial infarction: incidence, natural history, and clinical relevance. Circulation. 1986;73:294–9.

    Article  CAS  PubMed  Google Scholar 

  21. Fishbein MC, Y-Rit J, Lando U, Kanmatsuse K, Mercier JC, Ganz W. The relationship of vascular injury and myocardial hemorrhage to necrosis after reperfusion. Circulation. 1980;62:1274–9.

    Article  CAS  PubMed  Google Scholar 

  22. El-Tamimi H, Davies GJ, Sritara P, Hackett D, Crea F, Maseri A. Inappropriate constriction of small coronary vessels as a possible cause of a positive exercise test early after successful coronary angioplasty. Circulation. 1991;84:2307–12.

    Article  CAS  PubMed  Google Scholar 

  23. Skyschally A, Leineweber K, Gres P, Haude M, Erbel R, Heusch G. Coronary microembolization. Basic Res Cardiol. 2006;101:373–82.

    Article  PubMed  Google Scholar 

  24. Cavallini C, Savonitto S, Violini R, Arraiz G, Plebani M, Olivari Z, Rubartelli P, Battaglia S, Niccoli L, Steffenino G, Ardissino D. Impact of the elevation of biochemical markers of myocardial damage on long-term mortality after percutaneous coronary intervention: results of the CK-MB and PCI study. Eur Heart J. 2005;26:1494–8.

    Article  PubMed  Google Scholar 

  25. Gibson CM, Cannon CP, Murphy SA, Ryan KA, Mesley R, Marble SJ, McCabe CH, Van De Werf F, Braunwald E. Relationship of TIMI myocardial perfusion grade to mortality after administration of thrombolytic drugs. Circulation. 2000;101:125–30.

    Article  CAS  PubMed  Google Scholar 

  26. van’t Hof AW, Liem A, Suryapranata H, Hoorntje JC, de Boer MJ, Zijlstra F. Angiographic assessment of myocardial reperfusion in patients treated with primary angioplasty for acute myocardial infarction: myocardial blush grade. Zwolle myocardial infarction study group. Circulation. 1998;97:2302–6.

    Article  Google Scholar 

  27. Wilson RF, Laxson DD, Lesser JR, White CW. Intense microvascular constriction after angioplasty of acute thrombotic coronary arterial lesions. Lancet. 1989;1:807–11.

    Article  CAS  PubMed  Google Scholar 

  28. van’t Hof AW, Liem A, de MJ B, Zijlstra F. Clinical value of 12-lead electrocardiogram after successful reperfusion therapy for acute myocardial infarction. Zwolle myocardial infarction study group. Lancet. 1997;350:615–9.

    Article  Google Scholar 

  29. Giugliano RP, Sabatine MS, Gibson CM, Roe MT, Harrington RA, Murphy SA, Morrow DA, Antman EM, Braunwald E. Combined assessment of thrombolysis in myocardial infarction flow grade, myocardial perfusion grade, and ST-segment resolution to evaluate epicardial and myocardial reperfusion. Am J Cardiol. 2004;93:1362–7. A5–A6

    Article  PubMed  Google Scholar 

  30. Shroder R. Prognostic impact of early ST-segment resolution in acute ST-elevation myocardial infarction. Circulation. 2004;110:e506–10.

    Article  Google Scholar 

  31. Schofer J, Montz R, Mathey D. Scintigraphic evidence of the‘no-reflow’ phenomenon in human beings after coronarythrombolysis. J Am Coll Cardiol. 1985;5:593–8.

    Article  CAS  PubMed  Google Scholar 

  32. Iwakura K, Ito H, Nishikawa N, Hiraoka K, Sugimoto K, Higashino Y, Masuyama T, Hori M, Fujii K, Minamino T. Early temporal changes in coronary flow velocity patterns in patients with acute myocardial infarction demonstrating the ‘no-reflow’ phenomenon. Am J Cardiol. 1999;84:415–9.

    Article  CAS  PubMed  Google Scholar 

  33. Ito H, Tomooka T, Sakai N, Yu H, Higashino Y, Fujii K, Masuyama T, Kitabatake A, Minamino T. Lack of myocardial perfusion immediately after successful thrombolysis. A predictor of poor recovery of left ventricular function in anterior myocardial infarction. Circulation [Internet]. 1992 [cited 2016 Dec 13]; 85:1699–705. Available from: http://www.ncbi.nlm.nih.gov/pubmed/1572028.

    Article  CAS  PubMed  Google Scholar 

  34. Janardhanan R, Senior R. Accuracy of dipyridamole myocardial contrast echocardiography for the detection of residual stenosis of the infarct-related artery and multivessel disease early after acute myocardial infarction. J Am Coll Cardiol. 2004;43:2247–52.

    Article  PubMed  Google Scholar 

  35. Asanuma T, Tanabe K, Ochiai K, Yoshitomi H, Nakamura K, Murakami Y, Sano K, Shimada T, Murakami R, Morioka S, Beppu S. Relationship between progressive microvascular damage and intramyocardial hemorrhage in patients with reperfused anterior myocardial infarction: myocardial contrast echocardiographic study. Circulation. 1997;96:448–53.

    Article  CAS  PubMed  Google Scholar 

  36. Eeckhout E, Kern MJ. The coronary no-reflow phenomenon: a review of mechanisms and therapies. Eur Heart J [Internet]. 2001 [cited 2016 Dec 13];22:729–39. Available from: http://www.ncbi.nlm.nih.gov/pubmed/11350105.

    Article  CAS  PubMed  Google Scholar 

  37. Taylor AJ, Al-Saadi N, Abdel-Aty H, Schulz-Menger J, Messroghli DR, Friedrich MG. Detection of acutely impaired microvascular reperfusion after infarct angioplasty with magnetic resonance imaging. Circulation. 2004;109:2080–5.

    Article  PubMed  Google Scholar 

  38. Wu KC, Zerhouni EA, Judd RM, Lugo-Olivieri CH, Barouch LA, Schulman SP, Blumenthal RS, Lima JA. Prognostic significance of microvascular obstruction by magnetic resonance imaging in patients with acute myocardial infarction. Circulation. 1998;97:765–72.

    Article  CAS  PubMed  Google Scholar 

  39. Azzalini L, Millán X, Ly HQ, L’allier PL, Jolicoeur EM. Direct stenting versus pre-dilation in ST-elevation myocardial infarction: a systematic review and meta-analysis. J Interv Cardiol [Internet]. 2015 [cited 2016 Nov 7]; 28:119–31. Available from: http://doi.wiley.com/10.1111/joic.12190.

    Article  PubMed  Google Scholar 

  40. Bonios MJ, Pierrakos CN, Argiriou M, Dalianis A, Terrovitis JV, Dolou P, Drakos SG, Koudoumas D, Charitos CE, Anastasiou-Nana MI. Increase in coronary blood flow by intra-aortic balloon counterpulsation in a porcine model of myocardial reperfusion. Int J Cardiol [Internet]. 2010 [cited 2016 Nov 7]; 138:253–60. Available from: http://linkinghub.elsevier.com/retrieve/pii/S0167527308009649.

    Article  PubMed  Google Scholar 

  41. Ishihara M, Sato H, Tateishi H, Kawagoe T, Muraoka Y, Yoshimura M. Effects of intraaortic balloon pumping on coronary hemodynamics after coronary angioplasty in patients with acute myocardial infarction. Am Heart J [Internet]. 1992 [cited 2016 Nov 7];124:1133–8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/1442477.

    Article  CAS  PubMed  Google Scholar 

  42. Thiele H, Zeymer U, Neumann F-J, Ferenc M, Olbrich H-G, Hausleiter J, Richardt G, Hennersdorf M, Empen K, Fuernau G, Desch S, Eitel I, Hambrecht R, Fuhrmann J, Böhm M, Ebelt H, Schneider S, Schuler G, Werdan K. Intraaortic balloon support for myocardial infarction with cardiogenic shock. N Engl J Med. 2012;367:1287–96.

    Article  CAS  PubMed  Google Scholar 

  43. Burzotta F, Testa L, Giannico F, Biondi-Zoccai GGL, Trani C, Romagnoli E, Mazzari M, Mongiardo R, Siviglia M, Niccoli G, Vita De M, Porto I, Schiavoni G, Crea F. Adjunctive devices in primary or rescue PCI: a meta-analysis of randomized trials. Int J Cardiol. 2008;123:313–21.

    Article  PubMed  Google Scholar 

  44. Lagerqvist B, Fröbert O, Olivecrona GK, Gudnason T, Maeng M, Alström P, Andersson J, Calais F, Carlsson J, Collste O, Götberg M, Hårdhammar P, Ioanes D, Kallryd A, Linder R, Lundin A, Odenstedt J, Omerovic E, Puskar V, Tödt T, Zelleroth E, Östlund O, James SK. Outcomes 1 year after thrombus aspiration for myocardial infarction. N Engl J Med [Internet]. 2014 [cited 2016 Oct 19]; 371:1111–20. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25176395.

    Article  CAS  PubMed  Google Scholar 

  45. Sharma V, Jolly SS, Hamid T, Sharma D, Chiha J, Chan W, Fuchs F, Bui S, Gao P, Kassam S, Leung RCM, Horák D, Romppanen HO, El-Omar M, Chowdhary S, Stanković G, Kedev S, Rokoss MJ, Sheth T, Džavík V, Overgaard CB. Myocardial blush and microvascular reperfusion following manual thrombectomy during percutaneous coronary intervention for ST elevation myocardial infarction: insights from the TOTAL trial. Eur Heart J [Internet]. 2016 [cited 2016 Oct 19]; 37:1891–8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/27125948.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Jolly SS, Cairns JA, Yusuf S, Rokoss MJ, Gao P, Meeks B, Kedev S, Stankovic G, Moreno R, Gershlick A, Chowdhary S, Lavi S, Niemela K, Bernat I, Cantor WJ, Cheema AN, Steg PG, Welsh RC, Sheth T, Bertrand OF, Avezum A, Bhindi R, Natarajan MK, Horak D, Leung RCM, Kassam S, Rao S V, El-Omar M, Mehta SR, Velianou JL, et al. Outcomes after thrombus aspiration for ST elevation myocardial infarction: 1-year follow-up of the prospective randomised TOTAL trial. Lancet (London, England) [Internet]. 2016 [cited 2016 Oct 19]; 387:127–35. Available from: http://www.ncbi.nlm.nih.gov/pubmed/26474811.

    Article  Google Scholar 

  47. Windecker S, Kolh P, Alfonso F, Collet J-P, Cremer J, Falk V, Filippatos G, Hamm C, Head SJ, Jüni P, Kappetein AP, Kastrati A, Knuuti J, Landmesser U, Laufer G, Neumann F-J, Richter DJ, Schauerte P, Sousa Uva M, Stefanini GG, Taggart DP, Torracca L, Valgimigli M, Wijns W, Witkowski A. 2014 ESC/EACTS guidelines on myocardial revascularization: the task force on myocardial revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur Heart J. 2014;35:2541–619.

    Article  PubMed  Google Scholar 

  48. Petronio AS, Carlo De M, Ciabatti N, Amoroso G, Limbruno U, Palagi C, Di BV, Romano MF, Mariani M. Left ventricular remodeling after primary coronary angioplasty in patients treated with abciximab or intracoronary adenosine. Am Heart J. 2005;150:1015.

    Article  CAS  PubMed  Google Scholar 

  49. Thiele H, Schindler K, Friedenberger J, Eitel I, Fürnau G, Grebe E, Erbs S, Linke A, Möbius-Winkler S, Kivelitz D, Schuler G. Intracoronary compared with intravenous bolus abciximab application in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention: the randomized Leipzig immediate percutaneous coronary intervention abciximab IV. Circulation. 2008;118:49–57.

    Article  CAS  PubMed  Google Scholar 

  50. Akpek M, Sahin O, Sarli B, Baktir AO, Saglam H, Urkmez S, Ergin A, Oguzhan A, Arinc H, Kaya MG. Acute effects of intracoronary tirofiban on no-reflow phenomena in patients with ST-segment elevated myocardial infarction undergoing primary percutaneous coronary intervention. Angiology [Internet]. 2015 [cited 2016 Nov 7]; 66(6):560–7. Available from: http://ang.sagepub.com/cgi/doi/10.1177/0003319714545780.

    Article  CAS  PubMed  Google Scholar 

  51. Jaffe R, Charron T, Puley G, Dick A, Strauss BH. Microvascular obstruction and the no-reflow phenomenon after percutaneous coronary intervention. Circulation. 2008;117:3152–6.

    Article  PubMed  Google Scholar 

  52. Vijayalakshmi K, Whittaker VJ, Kunadian B, Graham J, Wright RA, Hall JA, Sutton A, Belder MA de. Prospective, randomised, controlled trial to study the effect of intracoronary injection of verapamil and adenosine on coronary blood flow during percutaneous coronary intervention in patients with acute coronary syndromes. Heart [Internet]. BMJ Group. 2006 [cited 2016 Nov 8]; 92(9):1278–84. Available from: http://www.ncbi.nlm.nih.gov/pubmed/16449518.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  53. Sdringola S, Assali A, Ghani M, Yepes A, Rosales O, Schroth GW, Fujise K, Anderson HV, Smalling RW. Adenosine use during aortocoronary vein graft interventions reverses but does not prevent the slow-no reflow phenomenon. Catheter Cardiovasc Interv. 2000;51:394–9.

    Article  CAS  PubMed  Google Scholar 

  54. Fischell TA, Carter AJ, Foster MT, Hempsall K, DeVries J, Kim DH, Kloostra A. Reversal of ‘no reflow’ during vein graft stenting using high velocity boluses of intracoronary adenosine. Catheter Cardiovasc Diagn. 1998;45:360–5.

    Article  CAS  Google Scholar 

  55. Ohno Y, Minatoguchi S, Uno Y, Kariya T, Arai M, Yamashita K, Fujiwara T, Fujiwara H. Nicorandil reduces myocardial infarct size by opening the K(ATP) channel in rabbits. Int J Cardiol. 1997;62:181–90.

    Article  CAS  PubMed  Google Scholar 

  56. Wu M, Huang Z, Xie H, Zhou Z. Nicorandil in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention: a systematic review and meta-analysis. Lionetti V, editor. PLoS One [Internet]. 2013 [cited 2016 Nov 7]; 8(10):e78231. Available from: http://dx.plos.org/10.1371/journal.pone.0078231.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  57. Gibson CM. Coronary and myocardial angiography: angiographic assessment of both epicardial and myocardial perfusion. Circulation [Internet]. 2004 [cited 2016 Nov 7]; 109:3096–105. Available from: http://circ.ahajournals.org/cgi/doi/10.1161/01.CIR.0000134278.50359.CB.

  58. Su Q, Li L, Naing KA, Sun Y. Safety and effectiveness of nitroprusside in preventing no-reflow during percutaneous coronary intervention: a systematic review. Cell Biochem Biophys [Internet]. 2014 [cited 2016 Nov 7]; 68(1):201–6. Available from: http://link.springer.com/10.1007/s12013-013-9690-9.

    Article  CAS  Google Scholar 

  59. TIMI Study Group. The Thrombolysis in Myocardial Infarction (TIMI) trial. Phase I findings. N Engl J Med. 1985;312:932–6.

    Article  Google Scholar 

  60. Henriques JPS, Zijlstra F, van‘t Hof AWJ, de Boer M-J, Dambrink J-HE, Gosselink M, Hoorntje JCA, Suryapranata H. Angiographic assessment of reperfusion in acute myocardial infarction by myocardial blush grade. Circulation. 2003;107:2115–9.

    Article  PubMed  Google Scholar 

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  1. Valduce Hospital, Como, Italy

    Alessandro Durante

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  1. Middle German Heart Center and Health Care Center Bitterfeld-Wolfen, gGmbH, Bitterfeld-Wolfen, Germany

    Peter Lanzer

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Durante, A. (2018). No-Reflow Phenomenon. In: Lanzer, P. (eds) Textbook of Catheter-Based Cardiovascular Interventions. Springer, Cham. https://doi.org/10.1007/978-3-319-55994-0_60

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