Pharmaceutical interventions for the management of no-reflow.

TL;DRAbstract

A common complication of percutaneous coronary intervention (PCI), no-reflow is predominantly encountered during interventions in degenerated saphenous vein grafts and is associated with a marked increase in short-term mortality risk. Etiologically, no-reflow is complex and multifactorial. Microembolic debris from dilated target sites, sustained diffuse microvascular spasm, and pathophysiologic alterations from initial ischemic insults and subsequent reperfusion injuries result in persistence of myocardial ischemia despite angiographic evidence of restored vessel patency. Treatments to prevent or reverse no-reflow include antiplatelet medications to interfere with platelet aggregation. However, insufficient evidence exists demonstrating benefits with their prophylactic use in humans. Distal protection devices target microemboli, but soluble vasoactive factors may elude capture, contributing to downstream vasospasm. Intracoronary administration of vasodilators during PCI address a root

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