Thursday, September 17, 2020

No-reflow or low reflow phenomenon in total coronary artery occlusion

What is the no-reflow or low reflow phenomenon?

If blood flow to the ischemic tissue continues to be impeded after relief of the occlusion.

Why does this happen?

After prolonged cessation of coronary perfusion and restoration of blood flow to the epicardial coronary arteries, structural damage occurs to the microvasculature that prevents the restoration of normal blood flow to the cardiac myocytes. Various mechanisms are implicated in the genesis of the no-reflow phenomenon.

How does it present? The contrast during cardiac catheterization will stagnate in the coronary artery. The patient will complain of chest pain, and hemodynamic compromise soon follows. 

What are the treatment options?

 Glycoprotein IIb/IIIa platelet receptor inhibitor: Because platelet and fibrin plugging is an important contributor to the pathogenesis of the no-reflow phenomenon.

Adenosine: Opening ATP-sensitive potassium channels may be involved in the vasodilatory effect

Nicorandil: Direct ATP potassium channel opener.

That's all!

-IkaN

Source: No-Reflow Phenomenon

https://www.ahajournals.org/doi/full/10.1161/hc0502.102867

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