The no-reflow phenomenon refers to the post-percutaneous coronary intervention condition in which,
despite re-establishing epicardial coronary vessel patency, the flow to the previously ischemic myocardium is
markedly reduced. When it does occur, it attenuates the beneficial effect of reperfusion therapy and substantial
regions of the myocardium fail to receive adequate perfusion. The pathophysiology of this phenomenon is not
completely understood. The possible mechanisms could be related to alterations in the microvascular circulation.
Various mechanisms such as activation of inflammatory pathways, vascular damage and hemorrhage, leukocyte
infiltration, and cellular edema may be responsible. As the no-reflow phenomenon is associated with adverse
clinical consequences, it is of great importance to identify exact responsible mechanisms and apply effective
preventive and therapeutic strategies. In this review, we describe an updated overview of the pathophysiological
mechanisms and the current preventive tools for no-reflow as well as therapeutic interventions in order to improve
coronary blood flow and consequently the prognosis for these patients.
Keywords: Microcirculation, coronary arteries, coronary circulation, no-reflow, endothelial dysfunction, post-percutaneous coronary
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