Recently, percutaneous coronary intervention has been the treatment of choice in most acute myocardial infarction cases. Although the results of percutaneous coronary interventions have ben good, the no-reflow phenomenon and distal embolization of intracoronary thrombus are still major problems even after successful interventions. In this article, we will briefly review the deleterious effects of no-reflow and distal embolization of intracoronary thrombus during percutaneous coronary interventions. The current trials focused on the prevention and treatment of the no-reflow phenomenon and intracoronary thrombus.
Myocardial Infarction ; No-Reflow Phenomenon ; Percutaneous Coronary Intervention ; Thrombosis

Drug-eluting balloon (DEB) with angioplasty a paclitaxel-coated balloon catheter is an effective treatment option in patients with in-stent restenosis (ISR) after a drug-eluting stent (DES). We describe a case in which 'no-reflow' phenomenon developed after DEB angioplasty of a DES ISR lesion. Coronary flow was restored after intracoronary administration of nicorandil.
Angioplasty ; Catheters ; Coronary Restenosis ; Drug-Eluting Stents ; Humans ; Nicorandil ; No-Reflow Phenomenon

The exact etiology of the coronary slow flow phenomenon (CSFP) is not certain. CSFP is not a normal variant as it is an absolutely pathological entity. Furthermore, CSFP not only leads to myocardial ischemia but it can also cause classical acute ST elevation myocardial infarction, which necessitates coronary angiography for a definite diagnosis.
Anterior Wall Myocardial Infarction ; Coronary Angiography ; Myocardial Infarction ; Myocardial Ischemia ; No-Reflow Phenomenon

BACKGROUND: The more vital organ blood flow during cardiopulmonary resuscitation (CPR), the more successful outcome. The worldwide CPR drug of choice, epinephrine also has some limitations and is often challenged by another catecholamine drug. This study was designed to compare the effects of epinephrine with those of vasopressin and epinephrine mixture on cerebral no-reflow during closed-chest CPR in a rabbit model of ventricular fibrillation. DESIGN: Prospective, randomized, experimental study. SETTING: University research laboratory. SUBJECTS: Domestic rabbits,3 to 6 months of age InteNentions : Four rabbits were randomly allocated to receive only 0.020 mg/kg of epinephrine(group 1) and another four rabbits were received both 0.020 mg/kg of epinephrine and 0.8 U/kg of vasopressin after 5 mins of cardiac arrest(group 2). MEASUREMENTS AND MAIN RESULTS: Carotid arterial blood flow and arterial gas analysis were showed no statistical difference between two groups but in the points of cerebral no reflow area and fluorescence exposure time, there were significant differences(group 1,5.15+/-.45%, group 2, 6.38+/-.54%, p=.029/ group 1; 29.65+/- 17.09 seconds, group 2;17.98+/- 18.75 seconds, p=.014). CONCLUSIONS: In cardiac arrest there is some synergistic effect with epinephrine and vasopressin mixture on cerebral no-reflow phenomenon.
Cardiopulmonary Resuscitation* ; Epinephrine* ; Fluorescence ; Heart Arrest ; No-Reflow Phenomenon ; Prospective Studies ; Rabbits ; Vasopressins* ; Ventricular Fibrillation

Distal embolization, such as plaque debris and thrombus during percutaneous coronary and carotid interventions, often lead to virtually untreatable small vessel occlusions and the no-reflow phenomenon, which may cause periprocedural end organ ischemia and infarction. This is clinically important as the one-year mortality is doubled in patients with a periprocedural myocardial infarction. To prevent a distal embolization a number of distal protection devices have been developed, with others still under development, such as a balloon occlusion device (PercuSurge GuardWire), numerous filter devices (FilterWire EX, AngioGuard, Mednova Neuroshield, AccuNet) and a catheter occlusion device (Parodi Anti-Emboli System). The usefulness and roles of distal protection devices, for cardiovascular intervention, are reviewed.
Angioplasty, Balloon ; Balloon Occlusion ; Catheters ; Humans ; Infarction ; Ischemia ; Mortality ; Myocardial Infarction ; No-Reflow Phenomenon ; Thrombosis

Profound reduction of anterograde coronary flow with concomitant ischemia is seen occasionally during percutaneous coronary intervention despite technically successful procedure. We found interesting coronary flow pattern in a patient with acute myocardial infarction, showing angiographic no reflow phenomenon after direct PTCA. The coronary blood flow pattern of the angiographic no-reflow phenomenon in this case was characterized by minimal systolic flow and sharp deceleration of diastolic flow. Coronary flow reserve calculated by the ratio of adenosine induced maximal hyperemic velocity and basal velocity was reduced. The Dopplertipped guide wire was useful for observation of phasic coronary flow pattern of angiographic no-reflow phenomenon.
Adenosine ; Deceleration ; Humans ; Ischemia ; Myocardial Infarction* ; No-Reflow Phenomenon ; Percutaneous Coronary Intervention

Acute Coronary Syndrome ; therapy ; Angioplasty, Balloon, Coronary ; Humans ; No-Reflow Phenomenon ; prevention & control

Coronary air embolism is a rare event. We report a case in which an acute myocardial infarction occurred in the region supplied by the right coronary artery after the removal of a double-lumen hemodialysis catheter. Emergent coronary angiography revealed air bubbles obstructing the mid-segment of the right coronary artery with slow flow phenomenon distally. The patient expired due to myocardial infarction.
Catheters* ; Coronary Angiography ; Coronary Vessels ; Embolism ; Embolism, Air* ; Humans ; Myocardial Infarction ; No-Reflow Phenomenon ; Renal Dialysis*

BACKGROUND AND OBJECTIVES: There is limited information on the transient or persistent no reflow phenomenon in patients with acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI). SUBJECTS AND METHODS: The study analyzed 4329 patients with AMI from a Korean multicenter registry who underwent PCI using coronary stents (2668 ST-elevation and 1661 non-ST-elevation myocardial infarction [MI] patients): 4071 patients without any no reflow, 213 with transient no reflow (no reflow with final thrombolysis in myocardial infarction [TIMI] flow grade 3), and 45 with persistent no reflow (no reflow with final TIMI flow grade≤2). The primary endpoint was all-cause mortality during 3-year follow-up. We also analyzed the incidence of cardiac mortality, non-fatal MI, re-hospitalization due to heart failure, target vessel revascularization, and stent thrombosis. RESULTS: The persistent no reflow group was associated with higher all-cause mortality (hazard ratio [HR] 1.98, 95% confidence interval [CI] 1.08-3.65, p=0.028) and cardiac mortality (HR 3.28, 95% CI 1.54-6.95, p=0.002) compared with the normal reflow group. Transient no reflow increased all-cause mortality only when compared with normal reflow group (HR 1.58, 95% CI 1.11-2.24, p=0.010). When comparing transient and persistent no reflow, persistent no reflow was associated with increased all-cause mortality (46.7 vs. 24.4%, log rank p=0.033). CONCLUSION: The persistent no reflow phenomenon was associated with a poor in-hospital outcome and increased long-term mortality mainly driven by increased cardiac mortality compared to the transient no reflow phenomenon or normal reflow.
Follow-Up Studies ; Heart Failure ; Humans ; Incidence ; Mortality ; Myocardial Infarction* ; No-Reflow Phenomenon ; Percutaneous Coronary Intervention* ; Stents ; Thrombosis

BACKGROUND AND OBJECTIVES: Intravenous nicorandil infusion with percutaneous coronary intervention (PCI) has been reported to reduce reperfusion injury events and to improve cardiac function in patients with an acute myocardial infarction. However, there is limited information on the use of intra-coronary nicorandil. A prospective randomized single center study was designed to evaluate the efficacy of the use of intra-coronary nicorandil. SUBJECTS AND METHODS: Seventy-three patients with an acute ST segment elevation myocardial infarction were randomly assigned to the nicorandil group (n=37) or a control group (n=36); all patients received a PCI. In the nicorandil group of patients, 4 mg of intra-coronary nicorandil was infused directly into the infarct area prior to reperfusion (2 mg before ballooning, 2 mg before stenting). The composite endpoint was the incidence of ventricular arrhythmia, no-reflow and slow flow. We estimated the post thrombolysis in myocardial infarction (TIMI) grade, the myocardial perfusion grade after PCI and the short-term clinical outcome. RESULTS: The baseline characteristics were similar in both groups of patients. A significant difference was observed in the composite endpoint in the nicorandil group of patients as compared to the control group of patients (p=0.037). The achievement rate of post TIMI grade 3 was significantly higher in the nicorandil group of patients (p=0.019). The myocardial perfusion grade 1 was not observed in the nicorandil group of patients; however, it was observed in five patients in the control group (p=0.019). Major adverse cardiac events in hospital and in 30 days were similar between the two groups. CONCLUSION: Intra-coronary nicorandil infusion reduced the occurrence of no-reflow, slow reflow, reperfusion arrhythmia and improved the myocardial perfusion grade and TIMI flow during PCI. The results of this study showed that the use of intracoronary nicorandil improved the clinical outcome in patients with an acute myocardial infarction.
Achievement ; Arrhythmias, Cardiac ; Humans ; Incidence ; Myocardial Infarction ; Nicorandil ; No-Reflow Phenomenon ; Percutaneous Coronary Intervention ; Perfusion ; Prospective Studies ; Reperfusion ; Reperfusion Injury