No-Reflow During Coronary Interventions: A Narrative Review

Area of Science:

• Cardiology
• Interventional Cardiology
• Cardiovascular Research

Background:

• The coronary no-reflow phenomenon is a significant complication during percutaneous coronary interventions, particularly in acute coronary syndrome.
• Despite restoring epicardial artery flow, impaired microvascular perfusion leads to adverse events like heart failure and increased mortality.
• Current understanding of multifactorial pathophysiology and therapeutic strategies remains incomplete.

Purpose of the Study:

• To provide an integrated perspective on the multifactorial pathophysiology of coronary no-reflow.
• To review advances in diagnostic imaging and therapeutic options for managing this condition.
• To explore future directions, including AI-based predictive modeling and targeted microvascular treatments.

Main Methods:

• Comprehensive literature review integrating pathophysiology, diagnostic imaging, and therapeutic interventions.
• Analysis of systemic inflammation, thrombogenicity, ischemia-reperfusion injury, and distal embolization.
• Evaluation of current and emerging treatments, including antithrombotics, vasodilators, and mechanical adjuncts.

Main Results:

• No-reflow involves complex interactions of inflammation, clotting, reperfusion injury, and embolization.
• Advanced imaging like cardiac MRI and CT aids in diagnosis and understanding.
• Existing therapies show limitations, highlighting unmet clinical needs.

Conclusions:

• Personalized treatment approaches are crucial for improving outcomes in patients with coronary no-reflow.
• Future research should focus on AI for predictive modeling and novel microvascular therapies.
• Addressing no-reflow is essential for reducing mortality and improving long-term cardiovascular health.