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Ischemic time is associated with procedure-related no-reflow/slow-flow during perfusion balloon-assisted percutaneous

Hiroshi Abe1, Dai Ozaki2, Masato Tomaru1

  • 1Department of Cardiology, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu, 279-0021, Japan.

Cardiovascular Intervention and Therapeutics
|July 6, 2026
PubMed

Insights

Prolonged ischemic time in acute coronary syndrome (ACS) patients undergoing perfusion balloon-assisted percutaneous coronary intervention (PCI) predicts no-reflow/slow-flow. Early treatment within 6 hours may mitigate this risk.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Acute Coronary Syndromes

Background:

  • Perfusion balloons aid in reducing no-reflow/slow-flow in acute coronary syndrome (ACS) patients with thrombotic lesions.
  • Predictors for procedure-related no-reflow/slow-flow during perfusion balloon-assisted percutaneous coronary intervention (PCI) require further definition.

Purpose of the Study:

  • To identify predictors of procedure-related no-reflow/slow-flow in patients with ACS undergoing perfusion balloon-assisted PCI after achieving TIMI grade 3 flow.
  • To assess the association between ischemic time and the occurrence of no-reflow/slow-flow post-PCI.

Main Methods:

  • Retrospective cohort study involving 54 ACS patients who underwent perfusion balloon-assisted PCI.
  • Primary outcome: procedure-related no-reflow/slow-flow after initial flow restoration.
  • Multivariate analysis to determine predictors, with a focus on ischemic time (onset-to-PCI).

Main Results:

  • Procedure-related no-reflow/slow-flow occurred in 16.7% of patients (9 out of 54).
  • No-reflow/slow-flow was significantly more frequent in patients with ischemic time > 6 hours (p < 0.01).
  • Ischemic time > 6 hours was an independent predictor (aOR 9.79, p=0.015), with good model discrimination (AUC 0.80).

Conclusions:

  • Prolonged ischemic time (> 6 hours) is significantly associated with procedure-related no-reflow/slow-flow in ACS patients undergoing perfusion balloon-assisted PCI.
  • Early intervention in ACS may be crucial for preventing procedural complications like no-reflow/slow-flow.

Keywords:
Acute coronary syndromePercutaneous coronary interventionPerfusion balloonSlow-flow

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