Circulation. 2002;105:656-662
doi: 10.1161/hc0502.102867
doi: 10.1161/hc0502.102867
(Circulation. 2002;105:656.)
© 2002 American Heart Association, Inc.
Current Perspective |
No-Reflow Phenomenon
From the Department of Cardiology, Marshfield Clinic, Marshfield, Wis (S.H.R.), and The Heart Institute, Good Samaritan Hospital, Los Angeles, Calif (R.A.K.).
Correspondence to Shereif Rezkalla, MD, Director of Cardiovascular Research, Department of Cardiology, Marshfield Clinic, 1000 N Oak Ave, Marshfield, WI 54449. E-mail rezkalls@mfldclin.edu
Key Words: myocardial infarction • microcirculation • ischemia
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Introduction |
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Because total coronary artery occlusion was found in the early hours of transmural myocardial infarction, most of our research interest and treatment strategies focus on epicardial coronary arteries.1 Little attention, however, is paid to the coronary microvasculature. When a coronary artery is occluded, detrimental changes occur in the cardiac capillaries and arterioles. After relief of the occlusion, blood flow to the ischemic tissue may still be impeded, a phenomenon known as no reflow. This article attempts to provide an in-depth understanding of this phenomenon from the laboratory bench to the clinical arena.
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Historical Perspective |
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The no-reflow concept was first suggested in brain ischemia.2 Brains of rabbits that suffered a brief 2 1/2 minutes of ischemia had normal blood flow when the ischemia was relieved. When the rabbits were exposed to longer ischemic periods, normal flow to brain tissues was not restored, even after relief of the vessel obstruction. Prolonged ischemia resulted in significant changes in the microvasculature that interfered with normal flow to the brain cells. The existence of this phenomenon was confirmed in a variety of animal models of brain ischemia.3–6 It was also shown in a variety of other organs, including skin,7,8 skeletal muscle,9 and the kidney.10–12 Kloner et al13 sought to find out whether the no-reflow phenomenon would be observed in ischemic canine hearts and whether it was related to microvascular damage. Dogs were subjected to 40 or 90 minutes of proximal coronary artery occlusion. When the coronary occlusion was relieved after 40 minutes of occlusion, the blood flow
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