No-Reflow Phenomenon

Rezkalla, Shereif H.; Kloner, Robert A.

doi:10.1161/hc0502.102867

Cited by 536 publications

(380 citation statements)

References 147 publications

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“…Microemboli released into the microvasculature during intervention or thrombolysis also play a very important role in acute myocardial infarction.Yet, the mechanism of this phenomenon is still not clear. 3) No-reflow phenomenon may lead to acute myocardial infarction and result in inhospital mortality. 4) Intracoronary administration of verapamil, 1) adenosine, 5) nicorandil, 6) papaverine, 7) urokinase, 8) or tissue-type plasminogen activator through the intravenous route 9) has been attempted to treat no-reflow phenomenon.…”

Section: Discussionmentioning

confidence: 99%

Restoration of Normal Coronary Flow With Tirofiban by Intracoronary Administration for No-reflow Phenomenon After Stent Deployment

et al. 2005

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SUMMARYNo-reflow phenomenon is frequently observed during percutaneous coronary intervention in patients with acute coronary syndrome. It may jeopardize hemodynamic status or result in ischemic chest pain in these patients. Currently, there is no adequate solution for this problem. We report our experience with an acute coronary syndrome patient who developed no-reflow phenomenon associated with ST segment elevation and shock after percuteneous coronary balloon dilatation and stent deployment. Intracoronary administration of tirofiban immediately restored the coronary flow of the target vessel, and the disastrous condition reversed. Our experience suggests that intracoronary administration of tirofiban can be considered as an option in case of no-reflow phenomenon during percutaneous coronary intervention. (Int Heart J 2005; 46: 139-145)

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Section: Discussionmentioning

confidence: 99%

Restoration of Normal Coronary Flow With Tirofiban by Intracoronary Administration for No-reflow Phenomenon After Stent Deployment

et al. 2005

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“…The infarct area was larger in these patients, establishing a no-reflow CFV pattern before reperfusion therapy and possibly accounting, at least in part, for the increased risk of early CHF. However, microvascular injury is determined not only by the size of the infarct but also by reperfusion injury, 16 PTCA-induced thrombus, and atheroma fragmentation. 17 Indeed, patients with severe microvascular injury immediately after PTCA have a higher frequency of ST-segment re-elevation 11 or incomplete ST-segment resolution, 18 and a continuously declining post-PTCA velocity has been linked to vessel reocclusion.…”

Section: Discussionmentioning

confidence: 99%

Coronary Blood Flow Assessment After Successful Angioplasty for Acute Myocardial Infarction Predicts the Risk of Long-Term Cardiac Events

et al. 2004

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Background-Analysis of coronary flow velocity (CFV) in the recanalized infarct-related coronary artery (IRA) with a Doppler guidewire is useful for predicting recovery of regional left ventricular function, in-hospital complications, and survival. We postulated that the CFV pattern after IRA reperfusion for acute myocardial infarction (AMI) would predict long-term adverse cardiac events. Methods and Results-Sixty-eight consecutive patients with a first AMI underwent CFV measurement with a Doppler guidewire after successful reopening of the IRA by coronary angioplasty. At the end of follow-up, 3.8Ϯ1.7 years after AMI, 44 of the 65 surviving patients (67.7%) were free of long-term cardiac events. Univariate analysis showed that the following factors were predictive of an end point combining cardiac death, recurrent MI, and congestive heart failure: hypertension, age Ն65 years, time from onset of chest pain to PTCA Ն6 hours, peak creatine kinase Ͼ4000 IU/L, ejection fraction Յ50%, proximal left anterior descending artery occlusion, resting average peak velocity Յ10 cm/s, average systolic peak velocity Յ5 cm/s, a rapid diastolic deceleration time (Յ600 ms), and early retrograde systolic flow. In the final multivariate model, only age Ն65 years (OR, 3.6; 95% CI, 1.1 to 11.8; Pϭ0.03), time to PTCA Ն6 hours (OR, 2.9; 95% CI, 1.0 to 8.3; Pϭ0.04), and a rapid diastolic deceleration time (OR, 5.4; 95% CI, 1.5 to 19.3; Pϭ0.01) were independent predictors. Conclusions-The CFV pattern appears to be an accurate predictor of long-term cardiac events in patients having undergone successful reopening of the IRA after AMI, identifying a subset of at-risk patients.

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“…34 Microscopic examination of the territory of the infarct-related artery reveals extensive endothelial damage at the level of the coronary microcirculation. Moreover, the release of endothelium-derived vasoconstrictor factors such as endothelin-1 from the site of coronary intervention 35 may potentially contribute to the reduced flow and the extension of myocardial ischemia.…”

Section: Endothelial Function and The No-reflow Phenomenonmentioning

confidence: 99%