Chapter

Coronary No-Reflow and Microvascular Obstruction

Edited by Derek Hausenloy and Derek Yellon

in Cardioprotection

Published on behalf of Oxford University Press

ISBN: 9780199544769
Published online May 2011 | e-ISBN: 9780199607228 | DOI: http://dx.doi.org/10.1093/med/9780199544769.003.0005

Series: Oxford Cardiology Library

Coronary No-Reflow and Microvascular Obstruction

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• Following an AMI, the restoration of TIMI III coronary blood flow using thrombolytic therapy or primary percutaneous coronary intervention does not guarantee actual myocardial perfusion • In 40–60% of reperfused AMI cases, myocardial perfusion is impeded at the level of the capillaries due to microvascular obstruction (MVO)- a phenomenon termed coronary no-reflow • The presence of coronary no-reflow can be detected as impaired myocardial perfusion using non-invasive imaging modalities such as nuclear myocardial perfusion scanning, myocardial contrast echocardiography or contrast-enhanced cardiac magnetic resonance imaging • The presence of microvascular obstruction post-AMI is associated with a larger infarct size, impaired LV ejection fraction, adverse LV remodelling and poorer clinical outcomes • Current treatment strategies include; vasodilator therapy such as adenosine, calcium-channel blockers, and nitrates; distal protection to prevent microemboli; and glycoprotein IIb/IIIa inhibitors • Novel treatment strategies are required to prevent and treat coronary no-reflow, thereby improving myocardial perfusion, reducing myocardial infarct size, preserving LV ejection fraction, preventing LV remodeling and improving clinical outcomes.

Chapter.  3458 words.  Illustrated.

Subjects: Cardiovascular Medicine

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