Management of no-reflow

Despite considerable progress in percutaneous coronary interventions, the phenomenon of coronary no-reflow (NR) still represents a serious problem. It occurs when cardiac tissue fails to perfuse normally despite opening of the occluded vessel. The consequences of NR include infarct expansion, early congestive heart failure, ventricular arrhythmias and adverse left ventricular remodeling. All the actions that improve myocardial tissue perfusion should convert into a better prognosis and a better clinical outcome. The pathophysiology of NR is still not fully elucidated, and several mechanisms are proposed, with microvascular obstruction as the leading one. Despite considerable progress in the identification of the risks to NR development, no specific therapies have been developed so far. In this review, pharmacological and nonpharmacological interventions that might improve coronary blood flow are discussed.