Vascular Biology Center, Georgia Health Sciences University, Augusta, GA; Department of Medicine, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY.
Division of Cardiovascular Medicine, Georgia Health Sciences University, Augusta, GA.
Rev Cardiovasc Med. 2014;15(1):38-51. doi: 10.3909/ricm0699.
The coronary no-reflow phenomenon refers to the post-percutaneous coronary intervention (PCI) state in which, despite successful revascularization of the epicardial conduit coronary arteries, substantial regions of the myocardium do not receive adequate perfusion. In most cases, the underlying mechanism can be attributed to alterations in the microvascular circulation caused by factors intrinsic or extrinsic to the coronary microcirculation. Because the no-reflow phenomenon is associated with poor clinical outcomes, it is of great importantance to identify and apply effective strategies for reducing post-PCI morbidity and mortality. Successful prevention strategies aim to ad dress increased vasoreactivity, intravascular platelet aggregation, microvascular inflammation, and down-stream plaque particle embolization. This review provides an updated overview on the pathomechanism of no-reflow and the current available prevention strategies from the perspective of coronary microcirculation. Although large randomized clinical trials have not yet identified any effective treatment, studying the coronary microcirculation may reveal new therapeutic targets for successful amelioration of the adverse clinical consequences from no-reflow phenomenon.
冠状动脉无复流现象是指经皮冠状动脉介入治疗（PCI）后，尽管心外膜冠状动脉主干已成功再通，但心肌的实质性区域仍未得到充分灌注。在大多数情况下，其潜在机制可归因于冠状动脉微循环固有或外在因素引起的微血管循环改变。由于无复流现象与不良临床结局相关，因此确定并应用有效策略来降低 PCI 后发病率和死亡率至关重要。成功的预防策略旨在解决血管过度反应、血管内血小板聚集、微血管炎症和下游斑块颗粒栓塞等问题。本文从冠状动脉微循环的角度，就无复流现象的病理机制和当前可用的预防策略提供了最新综述。尽管大型随机临床试验尚未确定任何有效治疗方法，但研究冠状动脉微循环可能为成功改善无复流现象的不良临床后果提供新的治疗靶点。
