The "no-reflow" phenomenon: basic science and clinical correlates.
Authors:
Journal: Heart (British Cardiac Society)
Publication Type: Case Reports
Date: 2002
DOI: PMC1767011
ID: 11796561
Reference List
- Kloner RA, Ganote CE, Jennings RB. The “no-reflow” phenomenon after temporary coronary occlusion in dogs. J Clin Invest 1974;54:1496–508.
▸ This is the first article describing anatomical no-reflow after experimental myocardial infarction in the canine model, using thioflavin S as a marker of anatomical no-reflow. The corresponding ultrastructural changes of the microvasculature are evaluated by electron microscopy.|||Kloner RA, Rude RE, Carlson N, et al. Ultrastructural evidence of microvascular damage and myocardial cell injury after coronary artery occlusion: which comes first? Circulation 1980;62:945–52.
▸ The spatial and temporal distribution of ultrastructural alterations of the microvascular bed is evaluated in comparison to myocyte fine structure. Microvascular changes lagged behind myocyte changes of irreversible ischaemic damage.|||Ambrosio G, Weisman HF, Mannisi JA, et al. Progressive impairment of regional myocardial perfusion after initial restoration of postischemic blood flow. Circulation 1989;80:1846–61.
▸ This landmark article provides evidence of reperfusion injury at the microvascular level, demonstrating a substantial increase of anatomical no-reflow with ongoing reperfusion and a progressive decrease of tissue perfusion.|||Piana RN, Paik GY, Moscucci M, et al. Incidence and treatment of `no-reflow' after percutaneous coronary intervention. Circulation 1994;89:2514–18.
▸ In a retrospective analysis, the incidence of angiographical no-reflow in elective PTCA procedures as well as in primary PTCA for acute myocardial infarction is evaluated.|||Morishima I, Sone T, Okumura K, et al. Angiographic no-reflow phenomenon as a predictor of adverse long-term outcome in patients treated with percutaneous transluminal coronary angioplasty for first acute myocardial infarction. J Am Coll Cardiol 2000;36:1202–9.|||Ito H, Okamura A, Iwakura K, et al. Myocardial perfusion patterns related to thrombolysis in myocardial infarction perfusion grades after coronary angioplasty in patients with acute anterior wall myocardial infarction. Circulation 1996;93:1993–9.
▸ Systematic analysis of the relation between TIMI grade flow and MCE and its significance for functional recovery.|||Ragosta M, Camarano G, Kaul S, et al. Microvascular integrity indicates myocellular viability in patients with recent myocardial infarction: new insights using myocardial contrast echocardiography. Circulation 1994;89:2562–9.|||Sakuma T, Hayashi Y, Sumii K, et al. Prediction of short- and intermediate-term prognoses of patients with acute myocardial infarction using myocardial contrast echocardiography one day after recanalization. J Am Coll Cardiol 1998;32:890–7.|||Iwakura K, Ito H, Takiuchi S, et al. Alteration in the coronary blood flow velocity pattern in patients with no reflow and reperfused acute myocardial infarction. Circulation 1996;94:1269–75.
▸ First description of characteristic changes of intracoronary Doppler profiles in patients with no-reflow after acute myocardial infarction with a section of potential explanations of its pathophysiology (see discussion).|||Iwakura K, Ito H, Nishikawa N, et al. Early temporal changes in coronary flow velocity patterns in patients with acute myocardial infarction demonstrating the “no-reflow” phenomenon. Am J Cardiol 1999;84:415–19.|||Rochitte CE, Lima JA, Bluemke DA, et al. Magnitude and time course of microvascular obstruction and tissue injury after acute myocardial infarction. Circulation 1998;98:1006–14.|||Wu KC, Zerhouni EA, Judd RM, et al. Prognostic significance of microvascular obstruction by magnetic resonance imaging in patients with acute myocardial infarction. Circulation 1998;97:765–72.
▸ Even if a substantial percentage of the included patients were not available at follow up after 16 months, this elegant study was able to relate the occurrence of microvascular obstruction, visualised as magnetic resonance hypoenhancement after contrast injection, to cardiovascular complications. This is the first study that demonstrated a prognostic significance of microvascular dysfunction independent of its relation to infarct size.|||Santoro GM, Valenti R, Buonamici P, et al. Relation between ST-segment changes and myocardial perfusion evaluated by myocardial contrast echocardiography in patients with acute myocardial infarction treated with direct angioplasty. Am J Cardiol 1998;82:932–7.|||Przyklenk K, Kloner RA. “Reperfusion injury” by oxygen-derived free radicals? Effect of superoxide dismutase plus catalase, given at the time of reperfusion, on myocardial infarct size, contractile function, coronary microvasculature, and regional myocardial blood flow. Circ Res 1989;64:86–96.|||Richard V, Kaeffer N, Tron C, et al. Ischemic preconditioning protects against coronary endothelial dysfunction induced by ischemia and reperfusion. Circulation 1994;89:1254–61.|||Golino P, Ragni M, Cirillo P, et al. Recombinant human, active site-blocked factor VIIa reduces infarct size and no-reflow phenomenon in rabbits. Am J Physiol 2000;278:H1507–16.|||Topol EJ, Yadav JS. Recognition of the importance of embolization in atherosclerotic vascular disease. Circulation 2000;101:570–80.
▸ Excellent review on the role of coronary microembolisation in various clinical situations of unstable coronary syndromes and percutaneous interventions.|||Hamm CW, Heeschen C, Goldman B, et al, for the CAPTURE Investigators. Benefit of abciximab in patients with refractory unstable angina in relation to serum troponin T levels. N Engl J Med 1999;340:1623–9.
▸ One of the most convincing studies on glycoprotein IIb/IIIa receptor blockade, which demonstrates the beneficial effects of glycoprotein IIb/IIIa receptor antagonism in unstable angina on clinical outcome.|||Ito H, Taniyama Y, Iwakura K, et al. Intravenous nicorandil can preserve microvascular integrity and myocardial viability in patients with reperfused anterior wall myocardial infarction. J Am Coll Cardiol 1999;33:654–60.
▸ This study demonstrated beneficial effects of intravenous nicorandil, initiated before reperfusion therapy, on microvascular function and myocardial viability by MCE.|||Taniyama Y, Ito H, Iwakura K, et al. Beneficial effect of intracoronary verapamil on microvascular and myocardial salvage in patients with acute myocardial infarction. J Am Coll Cardiol 1997;30:1193–9.