Research progress in the treatment of coronary no-reflow phenomenon

Cardiovascular disease is a common cause of death worldwide. With the acceleration of population aging, the incidence of acute coronary syndrome (ACS), represented by acute myocardial infarction, is increasing every year. When ACS occurs, coronary blood flow must be restored as soon as possible, and emergency percutaneous coronary intervention (PCI) remains the preferred treatment option. No-reflow phenomenon is a common complication after PCI, it refers to the normal opening of epicardial coronary stenosis or occlusion during coronary intervention, but the blood myocardial tissue has not been effectively re-perfused because the blood at the microcirculation level cannot be completely recovered. When coronary no-reflow phenomenon occurs, the beneficial effect of reperfusion therapy is weakened, and the incidence of major adverse cardiac events (MACES) is significantly increased, resulting in poor patient prognosis. At present, the pathophysiological mechanism of coronary no-reflow phenomenon is not fully understood, and it may be related to coronary microcirculation disorders. Molecular mechanisms include the activation of inflammatory pathways, endothelial cell damage caused by ischaemia and reperfusion, thromboembolism-related damage, microvascular spasm, leukocyte infiltration and cell oedema. No-reflow phenomenon is closely associated with poor clinical outcomes, thus, effective prevention and treatment strategies are important. Recent studies have shown that the preoperative prophylactic use of statins, antiplatelets, vasodilators and certain anti-inflammatory drugs can reduce the occurrence of no-reflow, restore coronary blood flow and improve patient outcomes. In addition, the preventive use of interventional devices has certain application potential. This article reviews the research progress in the prevention and treatment of coronary no-reflow phenomenon in recent years.