14 Feb Management of No-Reflow Phenomenon in the Catheterization Laboratory

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  1. JACC Cardiovasc Interv. 2017 Feb 13;10(3):215-223. doi: 10.1016/j.jcin.2016.11.059.

Management of No-Reflow Phenomenon in the Catheterization Laboratory.

Rezkalla SH1, Stankowski RV2, Hanna J3, Kloner RA4.
Author information:
· 1Department of Cardiology, Marshfield Clinic, Marshfield, Wisconsin. Electronic address: rezkalla.shereif@marshfieldclinic.org.
· 2Marshfield Clinic Research Foundation, Marshfield, Wisconsin.
· 3Lund University, Lund, Sweden.
· 4Huntington Medical Research Institute, Pasadena, California; Division of Cardiovascular Medicine, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California.


At the conclusion of a primary percutaneous coronary intervention for ST-segment elevation myocardial infarction, and after the cardiologist makes certain that there is no residual stenosis following stenting, assessment of coronary flow becomes the top priority. The presence of no-reflow is a serious prognostic sign. No-reflow can result in poor healing of the infarct and adverse left ventricular remodeling, increasing the risk for major adverse cardiac events, including congestive heart failure and death. To achieve normal flow, features associated with a high incidence of no-reflow must be anticipated, and measures must be undertaken to prevent its occurrence. In this review, the authors discuss various preventive strategies for no-reflow as well as pharmacological and nonpharmacological interventions that improve coronary blood flow, such as intracoronary adenosine and nitroprusside. Nonpharmacological therapies, such as induced hypothermia, were successful in animal studies, but their effectiveness in reducing no-reflow in humans remains to be determined.
Copyright © 2017 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
PMID: 28183461 [PubMed – in process]