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A prospective natural-history study of coronary atherosclerosis Influence of LDL-Cholesterol Lowering on Cardiovascular Outcomes in Patients With Diabetes Mellitus Undergoing Coronary Revascularization Sudden Cardiac Arrest Survivorship: A Scientific Statement From the American Heart Association Effects of Aspirin for Primary Prevention in Persons with Diabetes Mellitus Transcatheter Mitral-Valve Repair in Patients with Heart Failure Appropriate Use Criteria and Health Status Outcomes Following Chronic Total Occlusion Percutaneous Coronary Intervention: Insights From the OPEN-CTO Registry Uptake of Drug-Eluting Bioresorbable Vascular Scaffolds in Clinical Practice : An NCDR Registry to Practice Project Efficacy and safety of rosuvastatin vs. atorvastatin in lowering LDL cholesterol : A meta-analysis of trials with East Asian populations Coronary Artery Calcium Progression Is Associated With Coronary Plaque Volume Progression - Results From a Quantitative Semiautomated Coronary Artery Plaque Analysis Variation in Revascularization Practice and Outcomes in Asymptomatic Stable Ischemic Heart Disease

Review Article2018 Jul 5;20(9):44.

JOURNAL:Curr Atheroscler Rep. Article Link

Advances in Coronary No-Reflow Phenomenon-a Contemporary Review

Karimianpour A, Maran A. Keywords: Acute myocardial infarction; Coronary intervention; Microvascular obstruction; Myocardial perfusion; No-reflow; Slow-reflow

ABSTRACT


PURPOSE OF REVIEW - Coronary artery no-reflow phenomenon is an incidental outcome of percutaneous coronary intervention in patients presenting with acute myocardial infarction. Despite advances in pharmacologic and non-pharmacologic therapies, coronary no-reflow phenomenon occurs more commonly than desired. It often results in poor clinical outcomes and remains as a relevant consideration in the cardiac catheterization laboratory. In this systematic review, we have sought to discuss the topic in detail, and to relay the most recent discoveries and data on management of this condition.

 

RECENT FINDINGS - We discuss several pharmacologic and non-pharmacologic treatments used in the prevention and management of coronary no-reflow and microvascular obstruction. Covered topics include the understanding of pharmacologic mechanisms of current and future agents, and recent discoveries that may result in the development of future treatment options. We conclude that the pathophysiology of coronary no-reflow phenomenon and microvascular obstruction still remains incompletely understood, although several plausible theories have led to the current standard of care for its management. We also conclude that coronary no-reflow phenomenon and microvascular obstruction must be recognized as a multifactorial condition that has certain predispositions and characteristics, therefore its prevention and treatment must begin pre-procedurally and be multi-faceted including certain medications and operator techniques in the cardiac catheterization laboratory.