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No-reflow during percutaneous coronary intervention (PCI) is observed most commonly during saphenous vein graft intervention, rotational atherectomy and primary PCI for acute ST-elevation myocardial infarction. The contributions of distal embolization and ischemia/reperfusion injury to the pathogenesis of no-reflow vary in these settings, as does prevention and management. Prevention of no-reflow in these high-risk groups is the best treatment strategy, employing antiplatelet agents, vasodilators and/or mechanical devices to prevent distal embolization. Once mechanical factors are excluded as a cause for reduced epicardial flow, the treatment of established no-reflow is mainly pharmacologic, since the obstruction occurs at the level of the microvasculature. Compared with patients in whom no-reflow is transient, refractory no-reflow is associated with a markedly increased risk of 30-day mortality.

Original publication




Journal article


Expert Rev Cardiovasc Ther

Publication Date





715 - 731


Adenosine, Animals, Atherectomy, Coronary, Collateral Circulation, Coronary Angiography, Coronary Circulation, Coronary Thrombosis, Humans, Myocardial Infarction, Myocardial Ischemia, Myocardial Reperfusion, Myocardial Reperfusion Injury, Myocardial Revascularization, Prostheses and Implants, Regional Blood Flow, Saphenous Vein, Thrombectomy, Ultrasonography, Interventional, Vasodilator Agents