No-reflow phenomenon during percutaneous coronary intervention: Contemporary insights into mechanisms, prediction,...

Area of Science:

• Cardiology
• Interventional Cardiology
• Cardiovascular Research

Background:

• No-reflow phenomenon is a frequent and detrimental complication of percutaneous coronary intervention (PCI).
• It is characterized by poor myocardial perfusion despite successful opening of the main coronary artery.
• This condition results from microvascular dysfunction due to embolization, ischemia-reperfusion injury, vasoconstriction, and patient factors like diabetes.

Purpose of the Study:

• To review the current understanding of the pathophysiology, prediction, prevention, and management of the no-reflow phenomenon.
• To highlight the role of intracoronary imaging in risk stratification and improving clinical outcomes after PCI.

Main Methods:

• This review synthesizes current knowledge on no-reflow, drawing from existing literature.
• It focuses on the evolution of predictive markers from angiography to intracoronary imaging.
• The review discusses integrated pharmacologic-procedural strategies and therapeutic interventions for managing no-reflow.

Main Results:

• No-reflow is associated with larger infarct sizes and poorer clinical outcomes.
• Intracoronary imaging offers superior risk stratification by identifying vulnerable plaques and embolization-prone lesions compared to traditional methods.
• Effective prevention and management involve tailored pharmacologic and procedural approaches, including vasodilators and optimized stent deployment.

Conclusions:

• Intracoronary imaging plays a pivotal role in predicting and managing the no-reflow phenomenon.
• Personalized treatment strategies, informed by advanced imaging and potentially AI, are crucial for reducing no-reflow and enhancing PCI success.
• Future research should focus on multimodality imaging and real-time physiological assessment for individualized patient care.