RT Book, Section
A1 Feldman, Ted
A1 Sanborn,  Timothy A.
A1 Tommaso,  Carl L.
A2 Samady, Habib
A2 Fearon, William F.
A2 Yeung, Alan C.
A2 King III, Spencer B.
SR Print(0)
ID 1146606255
T1 Embolization and No-Reflow During Percutaneous Coronary Intervention
T2 Interventional Cardiology, 2e
YR 2017
FD 2017
PB McGraw-Hill Education
PP New York, NY
SN 9780071820363
LK accesscardiology.mhmedical.com/content.aspx?aid=1146606255
RD 2023/06/09
AB Embolization  and  coronary  no-reflow  are  rare  but  important  complications  during  percutaneous  coronary  intervention  (PCI).  Recognition  and  treatment  are  important  in  that  they  may  reduce  or  prevent  myocardial  necrosis  and  serious  subsequent  complications.  Additionally,  nonclinical  events  may  occur  as  a  result  of  this  phenomenon,  and  prevention  where  possible  becomes  important.  Macroembolization  usually  is  due  to  macro-particles  and/or  blood  clots  that  may  occur  during  intervention  of  patients  with  acute  coronary  syndromes.  No-reflow  may  occur  due  to  the  embolization  of  micro-particulate  matter  as  debris  from  coronary  lesions,  activation  of  platelets,  and/or  release  of  vasoactive  substances  that  may  modulate  distal  vasculature.  No-reflow  is  defined  as  the  reduction  of  coronary  flow  in  the  absence  of  a  proximal  occlusive  lesion  with  resultant  myocardial  ischemia.  In  PCI  of  native  coronary  vessels  in  absence  of  acute  coronary  syndromes,  no-reflow  may  be  due  to  microvascular  spasm  and/or  platelet  microemboli.  When  PCI  is  performed  in  thrombotic  lesions,  such  as  in  acute  coronary  syndromes,  no-reflow  may  be  due  to  distal  embolization  of  thrombus.  During  saphenous  vein  graft  intervention  and  rotational  atherectomy,  it  is  most  often  related  to  embolization  of  degenerated  plaque  elements  including  thrombotic  and  atherosclerotic  debris.  Any  or  all  of  these  mechanisms  can  occur  simultaneously.