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Coronary No-Reflow Following Percutaenous Coronary Intervention

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PanVascular Medicine

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Abstract

Coronary no-reflow is a serious complication of percutaneous coronary intervention (PCI) which is caused by microvascular obstruction. The pathophysiology of no-reflow relates to the clinical setting in which it occurs. Microvascular obstruction may result from downstream distal embolization of particulate material from the epicardial coronary artery, as well as from in situ microvascular and myocardial tissue injury. Prophylactic strategies may avert the occurrence of no-reflow following PCI; however, the efficacy of interventions for the reversal of no-reflow once it has occurred is unproven.

Disclosure: Dr. Jaffe is Medical Director of Cardioflow Inc.

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Abbreviations

Cardioprotection:

An assortment of pharmacological and non-pharmacological measures designed to prevent cell injury and death.

Embolic protection device:

A device designed to trap particulate matter released during percutaneous intervention within the epicardial coronary artery and to prevent downstream embolization into the microvasculature.

No-reflow:

A state of reduced myocardial perfusion in the presence of a patent epicardial coronary artery, which results from microvascular obstruction.

Percutaneous coronary intervention:

A minimally invasive coronary revascularization procedure in which an occluded or narrowed coronary artery is opened by inflating a balloon, usually with implantation of a metallic stent within the treated lesion.

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Further Reading

  • Betgem RP, de Waard GA, Nijveldt R, Beek AM, Escaned J, van Royen N (2014) Intramyocardial haemorrhage after acute myocardial infarction. Nat Rev Cardiol. doi: 10.1038/nrcardio.2014.188. [Epub ahead of print] Review

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  • Kaul S (2014) The “no reflow” phenomenon following acute myocardial infarction: mechanisms and treatment options. J Cardiol 64(2):77–85

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Authors and Affiliations

  1. Cardiology Department, Lady Davis Carmel Medical Center, 7 Michal St., Haifa, 34362, Israel

    Ady Orbach & Ronen Jaffe

  2. Sunnybrook Health Sciences Centre, Toronto, ON, Canada

    Bradley H. Strauss

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  1. Ady Orbach
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  2. Bradley H. Strauss
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  1. Division of Cardiovascular Disease Department of Internal Medicine, Health Care Center Bitterfeld, Bitterfeld-Wolfen, Germany

    Peter Lanzer

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Orbach, A., Strauss, B.H., Jaffe, R. (2015). Coronary No-Reflow Following Percutaenous Coronary Intervention. In: Lanzer, P. (eds) PanVascular Medicine. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-37078-6_60

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