Endovascular prevention of distal embolism in pathogenesis of no-reflow phenomenon in percutaneous coronary interventions in patients with ST-segment elevation acute coronary syndrome

Close metadata

Recommended articles:

Giant pseudoaneurysm of the right coronary artery after successful percutaneous coronary intervention. Russian Cardiology Bulletin. 2023;(3):76-81

Predicting the results of rehabilitation treatment of patients with acute myocardial infarction who underwent coronary artery stenting: focus on the rehabilitation potential. Problems of Balneology, Physiotherapy and Exercise Therapy. 2023;(1):27-36

Single-stent and double-stent strategy for complex, true and false bifurcation lesions of the left main coronary artery in patients with acute coronary syndrome: a single-center retrospective analysis. Russian Journal of Cardiology and Cardiovascular Surgery. 2024;(1):29-40

Pathogenesis of no/slow-reflow phenomenon following percutaneous coronary intervention (PCI) in patients with acute coronary syndrome and ST-segment elevation (STEMI) requires constant and in-depth study. It is known that no-reflow phenomenon is complex and can be triggered by combination of the following factors: 1) distal embolism of infarct-related coronary artery; 2) myocardial ischemic damage in appropriate coronary basin; 3) myocardial reperfusion injury; 4) genetic predisposition to microvascular damage. The risk of no-reflow or slow-reflow phenomenon is present at any stage of PCI. Most often, no-reflow phenomenon occurs due to distal embolism following balloon inflation during pre-dilatation or stent implantation. Distal embolism of infarct-related coronary artery due to fragmentation and migration of atherothrombotic conglomerate during PCI is sufficiently studied. Endovascular prevention of slow/no-reflow phenomenon took place in different years of development of endovascular surgery, and some ones are used now. At various times, surgeons used mesh-covered stents, manual and rheolytic thrombaspiration, protection by filter traps, proximal protection from distal embolism by temporary occlusion of infarct-related coronary artery. However, manual thromboaspiration currently occupies its niche, and indications for this procedure are limited. Intravenous administration of platelet glycoprotein IIB/IIIA receptor inhibitors is the most effective and common pharmacological method for the treatment and prevention of no-reflow or slow-reflow phenomenon. Some authors suppose that direct stenting of infarct-related coronary artery without pre-dilatation reduces the risk of distal embolism. That is why this strategy may be preferable for revascularization in STEMI patients to reduce the risk of microvascular embolization.

Keywords:

no-reflow phenomenon

direct stenting

acute coronary syndrome with ST-segment elevation

percutaneous coronary intervention

Authors:

G.V. Sazanov

Stavropol Regional Clinical Hospital

ORCID: 0000-0003-0277-1880

Z.Kh. Shugushev

Peoples’ Friendship University of Russia

ORCID: 0000-0002-5335-5062

Received:

26.07.2023

Accepted:

28.08.2023

List of references:

Alekyan BG. Endovascular surgery. National leadership. T. 2. M.: Litterra. 2017;399-426. (In Russ.).
Sazanov GV, Belokon’ OS. The effect of predilation on the incidence of the no/slow-reflow phenomenon in patients with acute coronary syndrome with ST segment elevation. Kazan medical journal. 2020;101(2):284-288. (In Russ.). https://doi.org/10.17816/KMJ2020-284
Heusch G, Skyschally A, Kleinbongard P. Coronary microembolization and microvascular dysfunction. International Journal of Cardiology. 2018;258(5):17-23.
Montone RA, Camilli M, Del Buono MG, Meucci MC, Gurgoglione F, Russo M, Crea F, Niccoli G. «No-reflow»: update su diagnosi, fisiopatologia e strategie terapeutiche [No-reflow: update on diagnosis, pathophysiology and therapeutic strategies]. Giornale Italiano di Cardiologia. 2020;21(6 suppl 1):4S-14S. (In Italian). https://doi.org/10.1714/3373.33487
Zhou H, He XY, Zhuang SW, Wang J, Lai Y, Qi WG, Yao YA, Liu XB. Clinical and procedural predictors of no-reflow in patients with acute myocardial infarction after primary percutaneous coronary intervention. World Journal of Emergency Medicine. 2014;5(2):96-102. https://doi.org/10.5847/wjem.j.issn.1920-8642.2014.02.003
Zhuravlev AS, Azarov AV, Semitko SP, Ioseliani DG. The no-Reflow Phenomenon During Primary Percutaneous Coronary Intervention in Patients With ST-Segment Elevation Myocardial Infarction due to Massive Coronary Thrombosis. Pathogenesis and Predictors of no-Reflow. Kardiologiia. 2021;61(2):99-105. (In Russ.). https://doi.org/10.18087/cardio.2021.2.n1175
Yaméogo NV, Guenancia C, Porot G, Stamboul K, Richard C, Gudjoncik A, Hamblin J, Buffet P, Lorgis L, Cottin Y. Predictors of angiographically visible distal embolization in STEMI. Herz. 2020;45(3):288-292. https://doi.org/10.1007/s00059-018-4723-1
Ganyukov V.I., Azarov A.V., Bessonov I.S., Majskov V.V., Tarasov R.S., Frolov A.A. Syndrome of unrestored coronary blood flow. Krasnoyarsk: Versona; 2023. 23-50. ISBN 978-5-906477-45-3. (In Russ.).
Iskhakov MM, Tagirova DR, Gazizov NV, Nugaibekova LA, Sayfutdinov RG. «No-reflow» phenomenon: clinical aspects of reperfusion failure. Kazan medical journal. 2015;96(3):391-396. (In Russ.). https://doi.org/10.17750/KMJ2015-391
Li Y, Palmer A, Lupu L, Huber-Lang M. Inflammatory response to the ischaemia-reperfusion insult in the liver after major tissue trauma. European Journal of Trauma and Emergency Surgery. 2022;48(6):4431-4444. https://doi.org/10.1007/s00068-022-02026-6
Wang J, Toan S, Zhou H. New insights into the role of mitochondria in cardiac microvascular ischemia/reperfusion injury. Angiogenesis. 2020;23(3):299-314. https://doi.org/10.1007/s10456-020-09720-2
Wu MY, Yiang GT, Liao WT, Tsai AP, Cheng YL, Cheng PW, Li CY, Li CJ. Current Mechanistic Concepts in Ischemia and Reperfusion Injury. Cellular Physiology and Biochemistry. 2018;46(4):1650-1667. https://doi.org/10.1159/000489241
Yalcin Y, Biyik I, Akturk E, Hancer VS, Yalcin B, Tosu AR, Birant A, Erturk M. Association between endothelial nitric oxide synthase gene polymorphism (glu298asp) and coronary no-reflow phenomenon in acute myocardial infarction. Advances in Hygiene & Experimental Medicine. 2019;73:529-535. https://doi.org/10.5604/01.3001.0013.5253
Niccoli G, Montone RA, Ibanez B, Thiele H, Crea F, Heusch G, Bulluck H, Hausenloy DJ, Berry C, Stiermaier T, Camici PG, Eitel I. Optimized treatment of ST-elevation myocardial infarction. Circulation Research. 2019;125:245-258. https://doi.org/10.1161/CIRCRESAHA.119.315344
Claeys MJ, Bosmans J, De Ceuninck M, Beunis A, Vergauwen W, Vorlat A, Vrints CJ. Effect of intracoronary adenosine infusion during coronary intervention on myocardial reperfusion injury in patients with acute myocardial infarction. American Journal of Cardiology. 2004;94:9-13. https://doi.org/10.1016/j.amjcard.2004.03.021
Hori M, Inoue M, Kitakaze M, Koretsune Y, Iwai K, Tamai J, Ito H, Kitabatake A, Sato T, Kamada T. Role of adenosine in hyperemic response of coronary blood flow in microembolization. American Journal of Physiology-Heart and Circulatory Physiology. 1986;250(3 Pt 2):H509-518. https://doi.org/10.1152/ajpheart.1986.250.3.H509
Konijnenberg LSF, Damman P, Duncker DJ, Kloner RA, Nijveldt R, van Geuns RM, Berry C, Riksen NP, Escaned J, van Royen N. Pathophysiology and diagnosis of coronary microvascular dysfunction in ST-elevation myocardial infarction. Cardiovascular Research. 2020;116(4):787-805. https://doi.org/10.1093/cvr/cvz301
Sezer M, van Royen N, Umman B, Bugra Z, Bulluck H, Hausenloy DJ, Umman S. Coronary Microvascular Injury in Reperfused Acute Myocardial Infarction: A View From an Integrative Perspective. Journal of the American Heart Association. 2018;7(21):e009949. https://doi.org/10.1161/JAHA.118.009949
Limbruno U, De Carlo M, Pistolesi S, Micheli A, Petronio AS, Camacci T, Fontanini G, Balbarini A, Mariani M, De Caterina R. Distal embolization during primary angioplasty: Histopathologic features and predictability. American Heart Journal. 2005;150(1):102-108. https://doi.org/10.1016/j.ahj.2005.01.016
Reffelmann T, Kloner RA. The no-reflow phenomenon: A basic mechanism of myocardial ischemia and reperfusion. Basic Research in Cardiology. 2006;101(5):359-372. https://doi.org/10.1007/s00395-006-0615-2
Nair Rajesh G, Jayaprasad N, Madhavan S, Sudha Kumary V, Jayaprakash K, Raihanathul Misiriya KJ, Jayaprakash VL, George R. Predictors and prognosis of no-reflow during primary percutaneous coronary intervention. Proceedings (Baylor University. Medical Center). 2018;32(1):30-33. https://doi.org/10.1080/08998280.2018.1509577
Kumar R, Khan KA, Shah JA, Ammar A, Kumar D, Khowaja S, Sial JA, Kazmi S, Murtaza M, Karim M. Quantification Of Thrombus Burden As An Independent Predictor Of Intra-Procedural No-Reflow In Patients With St-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Revascularization. Journal of Ayub Medical College Abbottabad. 2022;34(2):288-294. https://doi.org/10.55519/JAMC-02-9698
Kariyanna PT, Ramalanjaona B, Al-Sadawi M, Jayarangaiah A, Hegde S, McFarlane IM. Coronary embolism and myocardial infarction: A Scoping Study. American Journal of Medical Case Reports. 2020;8(2):31-43. https://doi.org/10.12691/ajmcr-8-2-1
Henriques JP, Zijlstra F, van ‘t Hof AW, de Boer MJ, Dambrink JH, Gosselink M, Hoorntje JC, Suryapranata H. Angiographic assessment of reperfusion in acute myocardial infarction by myocardial blush grade. Circulation. 2003;107(16):2115-2119. https://doi.org/10.1161/01.CIR.0000065221.06430.ED
Neumann F-J, Gick M. Direct stenting in ST-elevation myocardials infarction: convenient, but not improving outcomes. European Heart Journal. 2018;39(26):2480-2483. https://doi.org/10.1093/eurheartj/ehy353
Jolly SS, Cairns JA, Yusuf S, Meeks B, Pogue J, Rokoss MJ, Kedev S, Thabane L, Stankovic G, Moreno R, Gershlick A, Chowdhary S, Lavi S, Niemelä K, Steg PG, Bernat I, Xu Y, Cantor WJ, Overgaard CB, Naber CK, Cheema AN, Welsh RC, Bertrand OF, Avezum A, Bhindi R, Pancholy S, Rao SV, Natarajan MK, ten Berg JM, Shestakovska O, Gao P, Widimsky P, Džavík V; TOTAL Investigators. Randomized trial of primary PCI with or without routine manual thrombectomy. The New England Journal of Medicine. 2015;372(15):1389-1398. https://doi.org/10.1056/NEJMoa1415098
Stone GW, Abizaid A, Silber S, Dizon JM, Merkely B, Costa RA, Kornowski R, Abizaid A, Wojdyła R, Maehara A, Dressler O, Brener SJ, Bar E, Dudek D. Prospective, Randomized, Multicenter Evaluation of a Polyethylene Terephthalate Micronet Mesh-Covered Stent (MGuard) in ST-Segment Elevation Myocardial Infarction: The MASTER Trial. JACC: Journal of the American College of Cardiology. 2012;60(19):1975-1984. https://doi.org/10.1016/j.jacc.2012.09.004
Jolly SS, Cairns JA, Yusuf S, Meeks B, Pogue J, Rokoss MJ, Kedev S, Thabane L, Stankovic G, Moreno R, Gershlick A, Chowdhary S, Lavi S, Niemelä K, Steg PG, Bernat I, Xu Y, Cantor WJ, Overgaard CB, Naber CK, Cheema AN, Welsh RC, Bertrand OF, Avezum A, Bhindi R, Pancholy S, Rao SV, Natarajan MK, ten Berg JM, Shestakovska O, Gao P, Widimsky P, Džavík V; TOTAL Investigators. Randomized trial of primary PCI with or without routine manual thrombectomy. The New England Journal of Medicine. 2015;372(15):1389-1398. https://doi.org/10.1056/NEJMoa1415098
Ibanez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H, Caforio ALP, Crea F, Goudevenos JA, Halvorsen S, Hindricks G, Kastrati A, Lenzen MJ, Prescott E, Roffi M, Valgimigli M, Varenhorst C, Vranckx P, Widimský P; ESC Scientific Document Group. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). European Heart Journal. 2018;39(2):119-177. https://doi.org/10.1093/eurheartj/ehx393
Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B, Chambers CE, Ellis SG, Guyton RA, Hollenberg SM, Khot UN, Lange RA, Mauri L, Mehran R, Moussa ID, Mukherjee D, Ting HH, O’Gara PT, Kushner FG, Ascheim DD, Brindis RG, Casey DE Jr, Chung MK, de Lemos JA, Diercks DB, Fang JC, Franklin BA, Granger CB, Krumholz HM, Linderbaum JA, Morrow DA, Newby LK, Ornato JP, Ou N, Radford MJ, Tamis-Holland JE, Tommaso CL, Tracy CM, Woo YJ, Zhao DX. 2015 ACC/AHA/SCAI Focused Update on Primary Percutaneous Coronary Intervention for Patients With ST-Elevation Myocardial Infarction: An Update of the 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention and the 2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction. JACC: Journal of the American College of Cardiology. 2016;67(10):1235-1250. https://doi.org/10.1016/j.jacc.2015.10.005
Huang YX, Cao Y, Chen Y, Qiu YG, Zheng JY, Liu YM, He JC, Zhao L, Li TC. AngioJet rheolytic thrombectomy in patients with thrombolysis in myocardial infarction thrombus grade 5: an observational study. Scientific Reports. 2022;12(1):5462. https://doi.org/10.1038/s41598-022-09507-z
Hibi K, Kozuma K, Maejima N, Sonoda S, Endo T, Tanaka H, Kyono H, Koshida R, Ishihara T, Awata M, Kume T, Tanabe K, Morino Y, Tsukahara K, Ikari Y, Fujii K, Yamasaki M, Yamanaka T, Sumiyoshi T, Yoshino H, Kimura K, Isshiki T; VAMPIRE 3 Investigators. Long-Term Clinical Outcomes After Filter Protection During Percutaneous Coronary Intervention in Patients With Attenuated Plaque-1-Year Follow up of the VAMPIRE 3 (Vacuum Aspiration Thrombus Reemoval 3) Trial. Circulation Journal. 2020;85(1):44-49. https://doi.org/10.1253/circj.CJ-20-0449
Tereshchenko AS, Merkulov EV, Samko AN. Glycoprotein IIb/IIIa Receptor Inhibitors in Patients with ST-Segment Elevation Myocardial Infarction and Primary Percutaneous Coronary Intervention. Rational Pharmacotherapy in Cardiology. 2019;15(6):918-927. (In Russ.). https://doi.org/10.20996/1819-6446-2019-15-6-918-927
Loubeyre C, Morice MC, Lefèvre T, Piéchaud JF, Louvard Y, Dumas P. A randomized comparison of direct stenting with conventional stent implantation in selected patients with acute myocardial infarction. JACC: Journal of the American College of Cardiology. 2002;39(1):15-21. https://doi.org/10.1016/s0735-1097(01)01701-6
Sabatier R, Hamon M, Zhao QM, Burzotta F, Lecluse E, Valette B, Grollier G. Could direct stenting reduce no-reflow in acute coronary syndromes? A randomized pilot study. American Heart Journal. 2002;143(6):1027-1032. https://doi.org/10.1067/mhj.2002.122509
Ballarino MA, Moreyra E Jr, Damonte A, Sampaolesi A, Woodfield S, Pacheco G, Caballero G, Picabea E, Baccaro J, Tapia L, Lascano ER. Multicenter randomized comparison of direct vs. conventional stenting: the DIRECTO trial. Catheterization and Cardiovascular Interventions. 2003;58(4):434-440.
Gasior M, Gierlotka M, Lekston A, Wilczek K, Zebik T, Hawranek M, Wojnar R, Szkodzinski J, Piegza J, Dyrbus K, Kalarus Z, Zembala M, Polonski L. Comparison of outcomes of direct stenting versus stenting after balloon predilation in patients with acute myocardial infarction (DIRAMI). American Journal of Cardiology. 2007;100(5):798-805. https://doi.org/10.1016/j.amjcard.2007.04.026
Ozdemir R, Sezgin AT, Barutcu I, Topal E, Gullu H, Acikgoz N. Comparison of direct stenting versus conventional stent implantation on blood flow in patients with ST-segment elevation myocardial infarction. Angiology. 2006;57(4):453-458. https://doi.org/10.1177/0003319706290620
Alak A, Lugomirski P, Aleksova N, Jolly SS. A Meta-Analysis of Randomized Controlled Trials of Conventional Stenting Versus Direct Stenting in Patients With Acute Myocardial Infarction. Journal of Invasive Cardiology. 2015;27(9):405-409.
Saad M, Stiermaier T, Fuernau G, Pöss J, de Waha-Thiele S, Desch S, Thiele H, Eitel I. Impact of direct stenting on myocardial injury assessed by cardiac magnetic resonance imaging and prognosis in ST-elevation myocardial infarction. International Journal of Cardiology. 2019;283:88-92. https://doi.org/10.1016/j.ijcard.2018.11.141
Kim BG, Cho SW, Seo J, Kim GS, Jin MN, Lee HY, Byun YS, Kim BO. Effect of direct stenting on microvascular dysfunction during percutaneous coronary intervention in acute myocardial infarction: a randomized pilot study. Journal of International Medical Research. 2022;50(9):3000605221127888. https://doi.org/10.1177/03000605221127888
Möckel M, Vollert J, Lansky AJ, Witzenbichler B, Guagliumi G, Peruga JZ, Brodie BR, Kornowski R, Dudek D, Farkouh ME, Parise H, Mehran R, Stone GW; Horizons-AMI Trial Investigators. Comparison of direct stenting with conventional stent implantation in acute myocardial infarction. American Journal of Cardiology. 2011;108(12):1697-1703. https://doi.org/10.1016/j.amjcard.2011.07.040
Kalayci A, Oduncu V, Karabay CY, Erkol A, Tanalp AC, Tanboga IH, Candan O, Gecmen C, Izgi IA, Kirma C. Outcomes of direct stenting in patients with ST-elevated myocardial infarction. Herz. 2018;43(5):447-454.
Sazanov GV, Shugushev ZK, Belokon OS, Ermakov SV, Khripunova AA. Dilation of the infarct-related coronary artery to reduce the incidence of the no-reflow phenomenon in STEMI patients. Innovative Medicine of Kuban. 2023;(3):54-61. (In Russ.). https://doi.org/10.35401/2541-9897-2023-26-3-54-61
Remkes WS, Somi S, Roolvink V, Rasoul S, Ottervanger JP, Gosselink AT, Hoorntje JC, Dambrink JH, de Boer MJ, Suryapranata H, van ‘t Hof AW; Acute Myocardial Infarction Study Group. Direct drug-eluting stenting to reduce stent restenosis: a randomized comparison of direct stent implantation to conventional stenting with pre-dilation or provisional stenting in elective PCI patients. JACC: Cardiovascular Interventions. 2014;7(7):751-758. https://doi.org/10.1016/j.jcin.2014.02.012
He J, Kong LC, Zeng JT, Shi BZ, An DA, Chen BH, Ding S, Li Z, Yang F, Yang YN, Yan FH, Xiu JC, Wang HW, Xu JR, Ge H, Pu J. Comparison of direct stenting with conventional strategy on myocardial impairments in ST-segment elevation myocardial infarction: a cardiac magnetic resonance imaging study. The International Journal of Cardiovascular Imaging. 2020;36(6):1167-1175. https://doi.org/10.1007/s10554-020-01812-w
Azzalini L, Millán X, Ly HQ, L’Allier PL, Jolicoeur EM. Direct stenting versus pre-dilation in ST-elevation myocardial infarction: a systematic review and meta-analysis. Journal of Interventional Cardiology. 2015;28(2):119-131. https://doi.org/10.1111/joic.12190
Scarparo P, Improta R, Wilschut J, Kardys I, Den Dekker WK, Daemen J, Zijlstra F, Van Mieghem NM, Diletti R. Very Long-Term Clinical Outcomes After Direct Stenting in Patients Presenting With ST-Segment Elevation Myocardial Infarction. Cardiovascular Revascularization Medicine. 2022;41:144-150. https://doi.org/10.1016/j.carrev.2022.01.014

Close metadata