Microvasculature in acute myocardial ischemia // Circulation. No-reflow phenomenon and prognosis in patients with acute myocardial infarction // Nat. Preprocedural statin medication reduces the extent of periprocedural non-Q-wave myocardial infarction // Circulation. Incidence and clinical significance of distal embolization during primary angioplasty for acute myocardial infarction // Eur. Henriques J., Zijlstra F., Ottervanger J.Giampaolo N., Buzzotta F., Gialuto L., Crea F.Pharmaceutical interventions for the management of no-reflow // J. Validation of the Global Registry of Acute Coronary Event (GRACE) risk score for in-hospital mortality in patients with acute coronary syndrome in Canada // Am. The coronary no-reflow phenomenon: a review of mechanisms and therapies // Eur. ST-segment resolution and infarct-related artery patency and flow after thrombolytic therapy: Thrombolysis in Myocardial Infarction (TIMI) 14 investigators // Am. De Lemos J.A., Antman E.M., Giugliano R.P.ACC/AHA 2007 Guidelines for the management of patients with unstable angina/non_ST_elevation myocardial infarction - executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction) // J.

Anderson J.L., Adams C.D., Antman E.M.Given the multifactorial nature of the В«no-reflowВ», further search for the novel methods for prevention and treatment of this phenomenon is needed. The most studied treatments of ongoing В«no-reflowВ» are: vasodilators administered intracoronary (verapamil, adenosine, sodium nitroprusside) at percutaneous coronary intervention or coronary artery bypass surgery systemic antiplatelet agents mechanical protection from distal embolization. For the most accurate В«no-reflowВ» diagnosis, different methods for myocardium visualization might be used. For diagnosing this phenomenon, angiographic grading of coronary blood flow restoration (Thrombolysis in Myocardial Infarction - TIMI) and myocardial perfusion (Myocardial Blush Grade - MBG) is recommended. Predisposition for В«no-reflowВ» might be associated with a number of local and systemic factors. In addition, В«no-reflowВ» increases the risk of death. Patients with В«no-reflowВ» have highly increased risk of complications such as reduced systolic function, heart muscle remodeling, dilatation, cardiac chambers hypertrophy/hyperplasia, left ventricular aneurysm etc. In case of planned endovascular interventions, В«no-reflowВ» prevalence ranges from 0.3 to 2%. In patients with acute coronary syndrome undergoing thrombolysis, percutaneous coronary intervention or coronary artery bypass surgery, the risk for В«no-reflowВ» is about 30% or more. Microvascular microemboli formation is also of particular importance in developing this phenomenon. The main reason for В«no-reflowВ» is microvascular damage, of both structural and functional nature. It is caused by a lack of adequate blood flow in tissues after successful recanalization of infarct-related artery and is of multifactorial nature. В«No-reflowВ» phenomenon is the most striking example of myocardial reperfusion clinical failure.

No reflow phenomenon