Cardiovascular Research

Coronary No-reflow Phenomenon.

Authors: Shereif H Rezkalla|||Robert A Kloner

Affiliations: + Expand

Abstract

No-reflow occurs in up to one third of patients with acute myocardial infarction during acute percutaneous intervention, and occasionally during elective interventions, particularly vein graft intervention. Multiple intracoronary medications will restore flow in most cases. We begin with 100 to 1000 mg of nitroprusside, verapamil, or adenosine at a similar dosage. We give it at 100-mg increments at high velocity. We inject it distally in the epicardial artery to avoid any systemic effect, and we do it through an intracoronary perfusion catheter. At times, we use prophylactic injections (prior to balloon inflation), particularly in vein graft intervention. Most of these strategies are not formally approved for treating no-reflow. However, reversing this condition with restoration of normal coronary flow is essential for an improved left ventricular function and a better cardiac outcome.

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Reference List

Angiology. 2001 Feb;52(2):137-41|||J Clin Invest. 1974 Dec;54(6):1496-508|||Cathet Cardiovasc Diagn. 1998 Dec;45(4):360-5|||Catheter Cardiovasc Interv. 2002 Oct;57(2):125-34|||Circulation. 2003 Sep 16;108(11):1316-23|||J Am Coll Cardiol. 2001 Apr;37(5):1335-43|||Eur Heart J. 1996 Mar;17 (3):344-53|||South Med J. 1996 Aug;89(8):820-3|||Am Heart J. 1995 Aug;130(2):239-43|||Am J Cardiol. 1995 Nov 1;76(12 ):861-8|||J Am Coll Cardiol. 1999 Dec;34(7):1932-8|||J Am Coll Cardiol. 1998 Sep;32(3):787-93|||Circulation. 2002 Mar 19;105(11):1285-90|||J Am Coll Cardiol. 2004 Apr 7;43(7):1291-8|||Circulation. 2002 Feb 5;105(5):656-62|||J Am Coll Cardiol. 1998 Oct;32(4):898-903|||Cathet Cardiovasc Diagn. 1996 Sep;39(1):1-6|||J Am Coll Cardiol. 1997 Nov 1;30(5):1193-9|||Catheter Cardiovasc Interv. 2002 Nov;57(3):305-9|||Catheter Cardiovasc Interv. 2002 Nov;57(3):310-1|||Circulation. 1999 Apr 20;99(15):1945-50|||Jpn Heart J. 2002 Nov;43(6):573-80|||J Invasive Cardiol. 2000 Feb;12(2):80-5|||J Nucl Med. 2000 Mar;41(3):393-9|||J Am Coll Cardiol. 2003 Jan 1;41(1):1-7|||J Invasive Cardiol. 2002 Jun;14 (6):299-302|||Circulation. 2000 Feb 8;101(5):570-80|||J Am Coll Cardiol. 1999 Mar;33(3):654-60|||Catheter Cardiovasc Interv. 2003 Jan;58(1):11-7|||Am Heart J. 2002 Jun;143(6):1027-32|||Circulation. 1998 Dec 15;98(24):2695-701|||Circulation. 1998 Mar 3;97(8):765-72|||J Am Coll Cardiol. 1996 Dec;28(7):1677-83|||Circulation. 1996 Sep 15;94(6):1269-75|||J Am Coll Cardiol. 2000 Oct;36(4):1202-9|||Jpn Circ J. 1997 May;61(5):455-8|||Catheter Cardiovasc Interv. 2000 Sep;51(1):27-31; discussion 32|||Acta Cardiol. 2002 Aug;57(4):305-8|||Am Heart J. 1996 Nov;132(5):959-63|||Am J Cardiol. 2000 Aug 1;86(3):269-74|||Cathet Cardiovasc Diagn. 1995 Aug;35(4):287-91, discussion 92-3|||Circulation. 2000 May 9;101(18):2154-9