Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.
Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China.
J Cereb Blood Flow Metab. 2024 Jan;44(1):19-37. doi: 10.1177/0271678X231208476. Epub 2023 Oct 19.
Acute ischemic stroke (AIS) afflicts millions of individuals worldwide. Despite the advancements in thrombolysis and thrombectomy facilitating proximal large artery recanalization, the resultant distal hypoperfusion, referred to "no-reflow" phenomenon, often impedes the neurological function restoration in patients. Over half a century of scientific inquiry has validated the existence of cerebral "no-reflow" in both animal models and human subjects. Furthermore, the correlation between "no-reflow" and adverse clinical outcomes underscores the necessity to address this phenomenon as a pivotal strategy for enhancing AIS prognoses. The underlying mechanisms of "no-reflow" are multifaceted, encompassing the formation of microemboli, microvascular compression and contraction. Moreover, a myriad of complex mechanisms warrant further investigation. Insights gleaned from mechanistic exploration have prompted advancements in "no-reflow" treatment, including microthrombosis therapy, which has demonstrated clinical efficacy in improving patient prognoses. The stagnation in current "no-reflow" diagnostic methods imposes limitations on the timely application of combined therapy on "no-reflow" post-recanalization. This narrative review will traverse the historical journey of the "no-reflow" phenomenon, delve into its underpinnings in AIS, and elucidate potential therapeutic and diagnostic strategies. Our aim is to equip readers with a swift comprehension of the "no-reflow" phenomenon and highlight critical points for future research endeavors.
急性缺血性脑卒中（AIS）影响着全球数百万人。尽管溶栓和取栓术的进步促进了近端大动脉再通，但由此导致的远端低灌注，即“无复流”现象，常阻碍患者神经功能的恢复。半个多世纪的科学研究已经证实了动物模型和人类中存在脑“无复流”现象。此外，“无复流”与不良临床结局之间的相关性强调了必须将其作为改善 AIS 预后的关键策略来解决这一现象。“无复流”的潜在机制是多方面的，包括微栓塞的形成、微血管压迫和收缩。此外，还有许多复杂的机制需要进一步研究。从机制探索中获得的见解促使“无复流”治疗的进展，包括微血栓形成治疗，其已在改善患者预后方面显示出临床疗效。当前“无复流”诊断方法的停滞限制了联合治疗在再通后“无复流”中的及时应用。本综述将回顾“无复流”现象的历史发展，深入探讨其在 AIS 中的基础，并阐明潜在的治疗和诊断策略。我们的目标是使读者快速了解“无复流”现象，并强调未来研究的重点。
