no-reflow phenomenon
Inadequate myocardial perfusion despite successful restoration of epicardial coronary flow during intervention.
Full Definition
The no-reflow phenomenon describes a condition where, despite successful recanalization of an epicardial coronary artery, adequate tissue-level perfusion is not restored due to microvascular dysfunction. This complication occurs in 5-25% of primary percutaneous coronary interventions, particularly in patients with large thrombus burden, long ischemic times, or extensive myocardial territory at risk. The underlying mechanisms include microvascular spasm, plugging by microemboli, tissue edema, and inflammatory responses. No-reflow is associated with larger infarct size, reduced left ventricular function, and worse clinical outcomes despite technically successful epicardial intervention.
Usage
Usage note: Document associated TIMI flow grade and myocardial blush grade when describing no-reflow.
In Context
- "Despite achieving TIMI 3 flow, the patient developed no-reflow phenomenon with poor myocardial blush." — Case report
- "Intracoronary adenosine was administered to treat the no-reflow phenomenon following stent deployment." — Procedure note