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No-Reflow Complicating Chronic Total Occlusion Coronary Revascularization
Gianni Dall'Ara1, Luca Testa, Carlo Tumscitz
1Cardiology Unit, Morgagni-Pierantoni Hospital, Cardiovascular Department ASL Romagna, via Forlanini 34, 47121 Forlì, Italy. dallara.gianni@gmail.com.
The Journal of Invasive Cardiology
|February 2, 2020
Summary
No-reflow is a rare complication of chronic total occlusion percutaneous coronary intervention (CTO-PCI), occurring in 0.43% of cases. Distal embolization is the likely cause, and intracoronary adenosine can effectively improve flow, though it carries a high risk of myocardial infarction.
Area of Science:
- Cardiology
- Interventional Cardiology
Background:
- Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) is a complex procedure.
- No-reflow is a potential complication that can lead to adverse outcomes.
Purpose of the Study:
- To assess the incidence of no-reflow during CTO-PCI.
- To analyze causes and management strategies for no-reflow.
- To identify risks associated with no-reflow in CTO procedures.
Main Methods:
- A multicenter observational study reviewed CTO-PCIs performed between January 2018 and April 2019.
- No-reflow was defined as Thrombolysis in Myocardial Infarction (TIMI) flow ≤1.
- Clinical, anatomical, and procedural characteristics were analyzed.
Main Results:
- Two out of 461 CTO-PCIs (0.43%) were complicated by no-reflow.
- Distal embolization was the most plausible cause in both cases.
- Intracoronary adenosine improved flow, and both patients experienced type 4a myocardial infarction.
Conclusions:
- No-reflow is a rare but serious complication of CTO recanalization.
- It is associated with a high risk of periprocedural myocardial infarction.
- Existing collateral circulation offers incomplete protection against ischemia during CTO-PCI.
