No-Reflow Phoenomenon by Intracoronary Thrombus in Acute Myocardial Infarction

Sang Yup Lim, Sang Yup Lim

Abstract

Recently, percutaneous coronary intervention has been the treatment of choice in most acute myocardial infarction cases. Although the results of percutaneous coronary interventions have ben good, the no-reflow phenomenon and distal embolization of intracoronary thrombus are still major problems even after successful interventions. In this article, we will briefly review the deleterious effects of no-reflow and distal embolization of intracoronary thrombus during percutaneous coronary interventions. The current trials focused on the prevention and treatment of the no-reflow phenomenon and intracoronary thrombus.

Keywords: Myocardial infarction; No-Reflow phenomenon; Percutaneous coronary intervention; Thrombus.

Conflict of interest statement

CONFLICT OF INTEREST STATEMENT: None declared.

References

    1. Antman EM, Anbe DT, Armstrong PW, Bates ER, Green LA, Hand M, et al. ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the 1999 Guidelines for the Management of Patients with Acute Myocardial Infarction) Circulation. 2004;110:e82–e292.
    1. Smith SC, Jr, Feldman TE, Hirshfeld JW, Jr, Jacobs AK, Kern MJ, King SB, 3rd, et al. ACC/AHA/SCAI 2005 guideline update for percutaneous coronary intervention: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/SCAI Writing Committee to Update 2001 Guidelines for Percutaneous Coronary Intervention) Circulation. 2006;113:e166–e286.
    1. Michaels AD, Gibson CM, Barron HV. Microvascular dysfunction in acute myocardial infarction: focus on the roles of platelet and inflammatory mediators in the no-reflow phenomenon. Am J Cardiol. 2000;85:50B–60B.
    1. Eeckhout E, Kern MJ. The coronary no-reflow phenomenon: a review of mechanisms and therapies. Eur Heart J. 2001;22:729–739.
    1. Jaffe R, Charron T, Puley G, Dick A, Strauss BH. Microvascular obstruction and the no-reflow phenomenon after percutaneous coronary intervention. Circulation. 2008;117:3152–3156.
    1. Topol EJ, Yadav JS. Recognition of the importance of embolization in atherosclerotic vascular disease. Circulation. 2000;101:570–580.
    1. Morishima I, Sone T, Okumura K, Tsuboi H, Kondo J, Mukawa H, et al. Angiographic no-reflow phenomenon as a predictor of adverse long-term outcome in patients treated with percutaneous transluminal coronary angioplasty for first acute myocardial infarction. J Am Coll Cardiol. 2000;36:1202–1209.
    1. McNamara RL, Herrin J, Bradley EH, Portnay EL, Curtis JP, Wang Y, et al. Hospital improvement in time to reperfusion in patients with acute myocardial infarction, 1999 to 2002. J Am Coll Cardiol. 2006;47:45–51.
    1. Diercks DB, Kontos MC, Chen AY, Pollack CV, Jr, Wiviott SD, Rumsfeld JS, et al. Utilization and impact of pre-hospital electrocardiograms for patients with acute ST-segment elevation myocardial infarction: data from the NCDR (National Cardiovascular Data Registry) ACTION (Acute Coronary Treatment and Intervention Outcomes Network) Registry. J Am Coll Cardiol. 2009;53:161–166.
    1. The Thrombolysis in Myocardial Infarction (TIMI) trial. Phase I findings. TIMI Study Group. N Engl J Med. 1985;312:932–936.
    1. Bellandi F, Leoncini M, Maioli M, Toso A, Gallopin M, Piero Dabizzi R. Markers of myocardial reperfusion as predictors of left ventricular function recovery in acute myocardial infarction treated with primary angioplasty. Clin Cardiol. 2004;27:683–688.
    1. Vicente J, Mewton N, Croisille P, Staat P, Bonnefoy-Cudraz E, Ovize M, et al. Comparison of the angiographic myocardial blush grade with delayed-enhanced cardiac magnetic resonance for the assessment of microvascular obstruction in acute myocardial infarctions. Catheter Cardiovasc Interv. 2009;74:1000–1007.
    1. Evola S, Cuttitta F, Evola G, Macaione F, Piraino D, Meschisi MC, et al. Early detection of coronary artery flow and myocardial perfusion impairment in hypertensive patients evidenced by myocardial blush grade (MBG) and thrombolysis in myocardial infarction (TIMI) frame count (TFC) Intern Med. 2012;51:1653–1660.
    1. Lee CH, Tai BC, Lau C, Chen Z, Low AF, Teo SG, et al. Relation between door-to-balloon time and microvascular perfusion as evaluated by myocardial blush grade, corrected TIMI frame count, and ST-segment resolution in treatment of acute myocardial infarction. J Interv Cardiol. 2009;22:437–443.
    1. Grines CL, Cox DA, Stone GW, Garcia E, Mattos LA, Giambartolomei A, et al. Coronary angioplasty with or without stent implantation for acute myocardial infarction. Stent Primary Angioplasty in Myocardial Infarction Study Group. N Engl J Med. 1999;341:1949–1956.
    1. Ito H, Tomooka T, Sakai N, Yu H, Higashino Y, Fujii K, et al. Lack of myocardial perfusion immediately after successful thrombolysis. A predictor of poor recovery of left ventricular function in anterior myocardial infarction. Circulation. 1992;85:1699–1705.
    1. Ito H, Okamura A, Iwakura K, Masuyama T, Hori M, Takiuchi S, et al. Myocardial perfusion patterns related to thrombolysis in myocardial infarction perfusion grades after coronary angioplasty in patients with acute anterior wall myocardial infarction. Circulation. 1996;93:1993–1999.
    1. Okamura A, Ito H, Iwakura K, Kurotobi T, Koyama Y, Date M, et al. Clinical implications of distal embolization during coronary interventional procedures in patients with acute myocardial infarction: quantitative study with Doppler guidewire. JACC Cardiovasc Interv. 2008;1:268–276.
    1. Kloner RA, Ganote CE, Jennings RB. The "no-reflow" phenomenon after temporary coronary occlusion in the dog. J Clin Invest. 1974;54:1496–1508.
    1. Kloner RA, Rude RE, Carlson N, Maroko PR, DeBoer LW, Braunwald E. Ultrastructural evidence of microvascular damage and myocardial cell injury after coronary artery occlusion: which comes first? Circulation. 1980;62:945–952.
    1. Reffelmann T, Hale SL, Li G, Kloner RA. Relationship between no reflow and infarct size as influenced by the duration of ischemia and reperfusion. Am J Physiol Heart Circ Physiol. 2002;282:H766–H772.
    1. Reffelmann T, Kloner RA. Is microvascular protection by cariporide and ischemic preconditioning causally linked to myocardial salvage? Am J Physiol Heart Circ Physiol. 2003;284:H1134–H1141.
    1. Kenner MD, Zajac EJ, Kondos GT, Dave R, Winkelmann JW, Joftus J, et al. Ability of the no-reflow phenomenon during an acute myocardial infarction to predict left ventricular dysfunction at one-month follow-up. Am J Cardiol. 1995;76:861–868.
    1. Niccoli G, Burzotta F, Galiuto L, Crea F. Myocardial no-reflow in humans. J Am Coll Cardiol. 2009;54:281–292.
    1. Rezkalla SH, Kloner RA. Coronary no-reflow phenomenon: from the experimental laboratory to the cardiac catheterization laboratory. Catheter Cardiovasc Interv. 2008;72:950–957.
    1. Reffelmann T, Hale SL, Dow JS, Kloner RA. No-reflow phenomenon persists long-term after ischemia/reperfusion in the rat and predicts infarct expansion. Circulation. 2003;108:2911–2917.
    1. Mehta RH, Harjai KJ, Boura J, Cox D, Stone GW, O'Neill W, et al. Primary Angioplasty in Myocardial Infarction (PAMI) Investigators. Prognostic significance of transient no-reflow during primary percutaneous coronary intervention for ST-elevation acute myocardial infarction. Am J Cardiol. 2003;92:1445–1447.
    1. Ross AM, Lundergan CF, Rohrbeck SC, Boyle DH, van den, Buller CH, et al. Rescue angioplasty after failed thrombolysis: technical and clinical outcomes in a large thrombolysis trial. GUSTO-1 Angiographic Investigators. Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries. J Am Coll Cardiol. 1998;31:1511–1517.
    1. Patel TN, Bavry AA, Kumbhani DJ, Ellis SG. A meta-analysis of randomized trials of rescue percutaneous coronary intervention after failed fibrinolysis. Am J Cardiol. 2006;97:1685–1690.
    1. Sutton AG, Campbell PG, Price DJ, Grech ED, Hall JA, Davies A, et al. Failure of thrombolysis by streptokinase: detection with a simple electrocardiographic method. Heart. 2000;84:149–156.
    1. Morishima I, Sone T, Mokuno S, Taga S, Shimauchi A, Oki Y, et al. Clinical significance of no-reflow phenomenon observed on angiography after successful treatment of acute myocardial infarction with percutaneous transluminal coronary angioplasty. Am Heart J. 1995;130:239–243.
    1. Ito H, Maruyama A, Iwakura K, Takiuchi S, Masuyama T, Hori M, et al. Clinical implications of the 'no reflow' phenomenon. A predictor of complications and left ventricular remodeling in reperfused anterior wall myocardial infarction. Circulation. 1996;93:223–228.
    1. Reimer KA, Hill ML, Jennings RB. Prolonged depletion of ATP and of the adenine nucleotide pool due to delayed resynthesis of adenine nucleotides following reversible myocardial ischemic injury in dogs. J Mol Cell Cardiol. 1981;13:229–239.
    1. Engler RL, Freeman GL, Covell JW. Regional venous return: nitroprusside effect in normal and chronically congested dogs. Am J Physiol. 1983;245:H814–H823.
    1. Nayler WG, Elz JS. Reperfusion injury: laboratory artifact or clinical dilemma? Circulation. 1986;74:215–221.
    1. Chiariello M, Ambrosio G, Cappelli-Bigazzi M, Perrone-Filardi P, Tritto I, Nevola E, et al. Reduction in infarct size by the phospholipase inhibitor quinacrine in dogs with coronary artery occlusion. Am Heart J. 1990;120:801–807.
    1. Moens AL, Claeys MJ, Timmermans JP, Vrints CJ. Myocardial ischemia/reperfusion-injury, a clinical view on a complex pathophysiological process. Int J Cardiol. 2005;100:179–190.
    1. Okamura A, Ito H, Iwakura K, Kawano S, Inoue K, Maekawa Y, et al. Detection of embolic particles with the Doppler guide wire during coronary intervention in patients with acute myocardial infarction: efficacy of distal protection device. J Am Coll Cardiol. 2005;45:212–215.
    1. Hori M, Inoue M, Kitakaze M, Koretsune Y, Iwai K, Tamai J, et al. Role of adenosine in hyperemic response of coronary blood flow in microembolization. Am J Physiol. 1986;250:H509–H518.
    1. Skyschally A, Schulz R, Erbel R, Heusch G. Reduced coronary and inotropic reserves with coronary microembolization. Am J Physiol Heart Circ Physiol. 2002;282:H611–H614.
    1. Skyschally A, Haude M, Dörge H, Thielmann M, Duschin A, van de Sand A, et al. Glucocorticoid treatment prevents progressive myocardial dysfunction resulting from experimental coronary microembolization. Circulation. 2004;109:2337–2342.
    1. Reffelmann T, Kloner RA. The "no-reflow" phenomenon: basic science and clinical correlates. Heart. 2002;87:162–168.
    1. Tarantini G, Cacciavillani L, Corbetti F, Ramondo A, Marra MP, Bacchiega E, et al. Duration of ischemia is a major determinant of transmurality and severe microvascular obstruction after primary angioplasty: a study performed with contrast-enhanced magnetic resonance. J Am Coll Cardiol. 2005;46:1229–1235.
    1. Wu KC, Zerhouni EA, Judd RM, Lugo-Olivieri CH, Barouch LA, Schulman SP, et al. Prognostic significance of microvascular obstruction by magnetic resonance imaging in patients with acute myocardial infarction. Circulation. 1998;97:765–772.
    1. Ragosta M, Camarano G, Kaul S, Powers ER, Sarembock IJ, Gimple LW. Microvascular integrity indicates myocellular viability in patients with recent myocardial infarction. New insights using myocardial contrast echocardiography. Circulation. 1994;89:2562–2569.
    1. Galasso G, Schiekofer S, D'Anna C, Gioia GD, Piccolo R, Niglio T, et al. No-reflow phenomenon: pathophysiology, diagnosis, prevention, and treatment. A review of the current literature and future perspectives. Angiology. 2014;65:180–189.
    1. Kotani J, Mintz GS, Pregowski J, Kalinczuk L, Pichard AD, Satler LF, et al. Volumetric intravascular ultrasound evidence that distal embolization during acute infarct intervention contributes to inadequate myocardial perfusion grade. Am J Cardiol. 2003;92:728–732.
    1. Kenner MD, Zajac EJ, Kondos GT, Dave R, Winkelmann JW, Joftus J, et al. Ability of the no-reflow phenomenon during an acute myocardial infarction to predict left ventricular dysfunction at one-month follow-up. Am J Cardiol. 1995;76:861–868.
    1. Henriques JP, Zijlstra F, Ottervanger JP, de Boer MJ, van't Hof AW, Hoorntje JC, et al. Incidence and clinical significance of distal embolization during primary angioplasty for acute myocardial infarction. Eur Heart J. 2002;23:1112–1117.
    1. Yip HK, Chen MC, Chang HW, Hang CL, Hsieh YK, Fang CY, et al. Angiographic morphologic features of infarct-related arteries and timely reperfusion in acute myocardial infarction: predictors of slow-flow and no-reflow phenomenon. Chest. 2002;122:1322–1332.
    1. Tanaka A, Kawarabayashi T, Nishibori Y, Sano T, Nishida Y, Fukuda D, et al. No-reflow phenomenon and lesion morphology in patients with acute myocardial infarction. Circulation. 2002;105:2148–2152.
    1. Heusch G, Schulz R, Haude M, Erbel R. Coronary microembolization. J Mol Cell Cardiol. 2004;37:23–31.
    1. Motoyama S, Kondo T, Anno H, Kizukuri T, Nakamura Y, Oshima K, et al. Relationship between thrombolytic therapy and perfusion defect detected by Gd-DTPA-enhanced fast magnetic resonance imaging in acute myocardial infarction. J Cardiovasc Magn Reson. 2001;3:237–245.
    1. Hong YJ, Jeong MH, Ahn Y, Kang JC, Mintz GS, Kim SW, et al. Intravascular ultrasound findings that are predictive of no reflow after percutaneous coronary intervention for saphenous vein graft disease. Am J Cardiol. 2012;109:1576–1581.
    1. Katayama T, Kubo N, Takagi Y, Funayama H, Ikeda N, Ishida T, et al. Relation of atherothrombosis burden and volume detected by intravascular ultrasound to angiographic no-reflow phenomenon during stent implantation in patients with acute myocardial infarction. Am J Cardiol. 2006;97:301–304.
    1. Amano H, Wagatsuma K, Yamazaki J, Ikeda T. Virtual histology intravascular ultrasound analysis of attenuated plaque and ulcerated plaque detected by gray scale intravascular ultrasound and the relation between the plaque composition and slow flow/no reflow phenomenon during percutaneous coronary intervention. J Interv Cardiol. 2013;26:295–301.
    1. Sakata K, Kawashiri MA, Ino H, Matsubara T, Uno Y, Yasuda T, et al. Intravascular ultrasound appearance of scattered necrotic core as an index for deterioration of coronary flow during intervention in acute coronary syndrome. Heart Vessels. 2012;27:443–452.
    1. Fischell TA. Pharmaceutical interventions for the management of no-reflow. J Invasive Cardiol. 2008;20:374–379.
    1. Harding SA. The role of vasodilators in the prevention and treatment of no-reflow following percutaneous coronary intervention. Heart. 2006;92:1191–1193.
    1. Pasceri V, Pristipino C, Pelliccia F, Granatelli A, Speciale G, Roncella A, et al. Effects of the nitric oxide donor nitroprusside on no-reflow phenomenon during coronary interventions for acute myocardial infarction. Am J Cardiol. 2005;95:1358–1361.
    1. Fugit MD, Rubal BJ, Donovan DJ. Effects of intracoronary nicardipine, diltiazem and verapamil on coronary blood flow. J Invasive Cardiol. 2000;12:80–85.
    1. McIvor ME, Undemir C, Lawson J, Reddinger J. Clinical effects and utility of intracoronary diltiazem. Cathet Cardiovasc Diagn. 1995;35:287–291.
    1. Taniyama Y, Ito H, Iwakura K, Masuyama T, Hori M, Takiuchi S, et al. Beneficial effect of intracoronary verapamil on microvascular and myocardial salvage in patients with acute myocardial infarction. J Am Coll Cardiol. 1997;30:1193–1199.
    1. Marzilli M, Orsini E, Marraccini P, Testa R. Beneficial effects of intracoronary adenosine as an adjunct to primary angioplasty in acute myocardial infarction. Circulation. 2000;101:2154–2159.
    1. Nolte D, Lehr HA, Messmer K. Adenosine inhibits postischemic leukocyte-endothelium interaction in postcapillary venules of the hamster. Am J Physiol. 1991;261:H651–H655.
    1. Mahaffey KW, Puma JA, Barbagelata NA, DiCarli MF, Leesar MA, Browne KF, et al. Adenosine as an adjunct to thrombolytic therapy for acute myocardial infarction: results of a multicenter, randomized, placebo-controlled trial: the Acute Myocardial Infarction STudy of ADenosine (AMISTAD) trial. J Am Coll Cardiol. 1999;34:1711–1720.
    1. Ross AM, Gibbons RJ, Stone GW, Kloner RA, Alexander RW AMISTAD-II Investigators. A randomized, double-blinded, placebo-controlled multicenter trial of adenosine as an adjunct to reperfusion in the treatment of acute myocardial infarction (AMISTAD-II) J Am Coll Cardiol. 2005;45:1775–1780.
    1. Lim SY, Bae EH, Jeong MH, Kang DG, Lee YS, Kim KH, et al. Effect of combined intracoronary adenosine and nicorandil on no-reflow phenomenon during percutaneous coronary intervention. Circ J. 2004;68:928–932.
    1. Assali AR, Sdringola S, Ghani M, Denkats AE, Yepes A, Hanna GP, et al. Intracoronary adenosine administered during percutaneous intervention in acute myocardial infarction and reduction in the incidence of "no reflow" phenomenon. Catheter Cardiovasc Interv. 2000;51:27–31.
    1. Genda S, Miura T, Miki T, Ichikawa Y, Shimamoto K. K(ATP) channel opening is an endogenous mechanism of protection against the no-reflow phenomenon but its function is compromised by hypercholesterolemia. J Am Coll Cardiol. 2002;40:1339–1346.
    1. Louis AA, Manousos IR, Coletta AP, Clark AL, Cleland JG. Clinical trials update: The Heart Protection Study, IONA, CARISA, ENRICHD, ACUTE, ALIVE, MADIT II and REMATCH. Impact Of Nicorandil on Angina. Combination Assessment of Ranolazine In Stable Angina. ENhancing Recovery In Coronary Heart Disease patients. Assessment of Cardioversion Using Transoesophageal Echocardiography. AzimiLide post-Infarct surVival Evaluation. Randomised Evaluation of Mechanical Assistance for Treatment of Chronic Heart failure. Eur J Heart Fail. 2002;4:111–116.
    1. Kloner RA, Dai W. Glycoprotein IIb/IIIa inhibitors and no-reflow. J Am Coll Cardiol. 2004;43:284–286.
    1. Kunichika H, Ben-Yehuda O, Lafitte S, Kunichika N, Peters B, DeMaria AN. Effects of glycoprotein IIb/IIIa inhibition on microvascular flow after coronary reperfusion. A quantitative myocardial contrast echocardiography study. J Am Coll Cardiol. 2004;43:276–283.
    1. Montalescot G, Barragan P, Wittenberg O, Ecollan P, Elhadad S, Villain P, et al. ADMIRAL Investigators. Abciximab before Direct Angioplasty and Stenting in Myocardial Infarction Regarding Acute and Long-Term Follow-up. Platelet glycoprotein IIb/IIIa inhibition with coronary stenting for acute myocardial infarction. N Engl J Med. 2001;344:1895–1903.
    1. Kandzari DE, Hasselblad V, Tcheng JE, Stone GW, Califf RM, Kastrati A, et al. Improved clinical outcomes with abciximab therapy in acute myocardial infarction: a systematic overview of randomized clinical trials. Am Heart J. 2004;147:457–462.
    1. De Luca G, Dudek D, Sardella G, Marino P, Chevalier B, Zijlstra F. Adjunctive manual thrombectomy improves myocardial perfusion and mortality in patients undergoing primary percutaneous coronary intervention for ST-elevation myocardial infarction: a meta-analysis of randomized trials. Eur Heart J. 2008;29:3002–3010.
    1. Bavry AA, Kumbhani DJ, Bhatt DL. Role of adjunctive thrombectomy and embolic protection devices in acute myocardial infarction: a comprehensive meta-analysis of randomized trials. Eur Heart J. 2008;29:2989–3001.
    1. Gick M, Jander N, Bestehorn HP, Kienzle RP, Ferenc M, Werner K, et al. Randomized evaluation of the effects of filter-based distal protection on myocardial perfusion and infarct size after primary percutaneous catheter intervention in myocardial infarction with and without ST-segment elevation. Circulation. 2005;112:1462–1469.
    1. Svilaas T, Vlaar PJ, van der Horst IC, Diercks GF, de Smet BJ, van den Heuvel AF, et al. Thrombus aspiration during primary percutaneous coronary intervention. N Engl J Med. 2008;358:557–567.
    1. Stone GW, Webb J, Cox DA, Brodie BR, Qureshi M, Kalynych A, et al. Enhanced Myocardial Efficacy and Recovery by Aspiration of Liberated Debris (EMERALD) Investigators. Distal microcirculatory protection during percutaneous coronary intervention in acute ST-segment elevation myocardial infarction: a randomized controlled trial. JAMA. 2005;293:1063–1072.
    1. Bavry AA, Kumbhani DJ, Bhatt DL. Role of adjunctive thrombectomy and embolic protection devices in acute myocardial infarction: a comprehensive meta-analysis of randomized trials. Eur Heart J. 2008;29:2989–3001.
    1. Vlaar PJ, Svilaas T, van der Horst IC, Diercks GF, Fokkema ML, de Smet BJ, et al. Cardiac death and reinfarction after 1 year in the Thrombus Aspiration during Percutaneous coronary intervention in Acute myocardial infarction Study (TAPAS): a 1-year follow-up study. Lancet. 2008;371:1915–1920.
    1. Fröbert O, Lagerqvist B, Olivecrona GK, Omerovic E, Gudnason T, Maeng M, et al. TASTE Trial. Thrombus aspiration during ST-segment elevation myocardial infarction. N Engl J Med. 2013;369:1587–1597.
    1. Jolly SS, Cairns JA, Yusuf S, Meeks B, Pogue J, Rokoss MJ, et al. TOTAL Investigators. Randomized trial of primary PCI with or without routine manual thrombectomy. N Engl J Med. 2015;372:1389–1398.
    1. Lagerqvist B, Fröbert O, Olivecrona GK, Gudnason T, Maeng M, Alström P, et al. Outcomes 1 year after thrombus aspiration for myocardial infarction. N Engl J Med. 2014;371:1111–1120.
    1. Noman A, Egred M, Bagnall A, Spyridopoulos I, Jamieson S, Ahmed J. Impact of thrombus aspiration during primary percutaneous coronary intervention on mortality in ST-segment elevation myocardial infarction. Eur Heart J. 2012;33:3054–3061.

Source: PubMed

3
Subscribe