no-reflow
Impaired myocardial perfusion despite restoration of epicardial coronary flow after reperfusion therapy.
Full Definition
No-reflow is a clinical phenomenon characterized by inadequate myocardial tissue perfusion despite successful restoration of flow in the epicardial coronary artery following reperfusion therapy. This condition typically occurs after primary percutaneous coronary intervention for acute myocardial infarction and is attributed to microvascular obstruction caused by a combination of distal embolization, inflammation, and reperfusion injury. No-reflow is associated with larger infarct size, reduced left ventricular function recovery, and worse clinical outcomes including increased mortality. The phenomenon can be detected angiographically by reduced TIMI flow grades or myocardial blush grades, and more sensitively by cardiac magnetic resonance imaging or myocardial contrast echocardiography. Prevention and treatment strategies include distal protection devices, pharmacological interventions, and optimized reperfusion techniques.
Usage
Usage note: Distinguish between angiographic and tissue-level no-reflow when reporting.
In Context
- "Despite achieving TIMI 3 flow, the patient developed no-reflow with poor myocardial perfusion." — Case report
- "No-reflow was defined as TIMI flow grade less than 3 or myocardial blush grade 0-1." — Study definition