冠状动脉无血流灌注的诊断、预防和治疗的实用方法

Lalita Nemani
{"title":"冠状动脉无血流灌注的诊断、预防和治疗的实用方法","authors":"Lalita Nemani","doi":"10.25259/ijcdw_18_2022","DOIUrl":null,"url":null,"abstract":"Coronary no-reflow (NR) defined as inadequate myocardial perfusion despite restoration of coronary artery patency is a bane for an interventional cardiologist. It can complicate percutaneous coronary interventions especially in the setting of STEMI and dampens the potential benefits of PPCI. Broadly classified as Reperfusion NR and Interventional NR, mechanism is multifactorial. The basic underlying culprit is microvascular obstruction either secondary to distal embolization, intravascular plugging, or ischemic reperfusion injury. Coronary angiogram is an easy, readily available, and essential modality to diagnose no-reflow, but the gold standard is gadolinium-enhanced cardiovascular magnetic resonance imaging. Preventive strategies for NR should be integral part of prePCI planning especially in clinical scenario where NR is expected such as STEMI with delayed presentation and high thrombus burden, atherectomy, and SVG PCI. The cornerstone of treatment for NR is local vasodilators and antiplatelet therapy to ameliorate vasospasm and thromboembolism respectively, and different combinations of the two should be used in no specific order to achieve reversal of NR. NR phenomenon is associated with poor short-term and long-term prognosis and every attempt should be made to avoid or reverse it. Therapeutic hypothermia, hyperoxemic reperfusion therapy, targeted anti-inflammatory approach, and cellular approach appear proising but further research is mandatory.","PeriodicalId":92905,"journal":{"name":"Indian journal of cardiovascular disease in women WINCARS","volume":"38 1","pages":""},"PeriodicalIF":0.0000,"publicationDate":"2023-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Practical Approach to Diagnosis, Prevention, and Management of Coronary No-Reflow\",\"authors\":\"Lalita Nemani\",\"doi\":\"10.25259/ijcdw_18_2022\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"Coronary no-reflow (NR) defined as inadequate myocardial perfusion despite restoration of coronary artery patency is a bane for an interventional cardiologist. It can complicate percutaneous coronary interventions especially in the setting of STEMI and dampens the potential benefits of PPCI. Broadly classified as Reperfusion NR and Interventional NR, mechanism is multifactorial. The basic underlying culprit is microvascular obstruction either secondary to distal embolization, intravascular plugging, or ischemic reperfusion injury. Coronary angiogram is an easy, readily available, and essential modality to diagnose no-reflow, but the gold standard is gadolinium-enhanced cardiovascular magnetic resonance imaging. Preventive strategies for NR should be integral part of prePCI planning especially in clinical scenario where NR is expected such as STEMI with delayed presentation and high thrombus burden, atherectomy, and SVG PCI. The cornerstone of treatment for NR is local vasodilators and antiplatelet therapy to ameliorate vasospasm and thromboembolism respectively, and different combinations of the two should be used in no specific order to achieve reversal of NR. NR phenomenon is associated with poor short-term and long-term prognosis and every attempt should be made to avoid or reverse it. Therapeutic hypothermia, hyperoxemic reperfusion therapy, targeted anti-inflammatory approach, and cellular approach appear proising but further research is mandatory.\",\"PeriodicalId\":92905,\"journal\":{\"name\":\"Indian journal of cardiovascular disease in women WINCARS\",\"volume\":\"38 1\",\"pages\":\"\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2023-02-15\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Indian journal of cardiovascular disease in women WINCARS\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.25259/ijcdw_18_2022\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Indian journal of cardiovascular disease in women WINCARS","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.25259/ijcdw_18_2022","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0

摘要

冠状动脉无血流灌注(NR)被定义为尽管冠状动脉通畅恢复心肌灌注不足,是介入心脏病专家的一个祸害。它可以使经皮冠状动脉介入治疗复杂化,特别是在STEMI的情况下,并抑制PPCI的潜在益处。NR分为再灌注NR和介入性NR,其机制是多因素的。基本的潜在罪魁祸首是继发于远端栓塞、血管内堵塞或缺血性再灌注损伤的微血管阻塞。冠状动脉造影是诊断无血流循环的一种简单、容易获得和必要的方法,但金标准是钆增强心血管磁共振成像。NR的预防策略应该是预ci计划的组成部分,特别是在预期NR的临床情况下,如延迟表现和高血栓负担的STEMI、动脉粥样硬化切除术和SVG PCI。NR治疗的基础是局部血管扩张剂和抗血小板治疗,分别改善血管痉挛和血栓栓塞,两者的不同组合不应按照特定的顺序使用,以实现NR的逆转。NR现象与短期和长期预后差有关,应尽力避免或逆转NR。治疗性低温,高氧再灌注治疗,靶向抗炎方法和细胞方法似乎很有希望,但进一步的研究是必要的。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
查看原文
分享 分享
微信好友 朋友圈 QQ好友 复制链接
本刊更多论文
Practical Approach to Diagnosis, Prevention, and Management of Coronary No-Reflow
Coronary no-reflow (NR) defined as inadequate myocardial perfusion despite restoration of coronary artery patency is a bane for an interventional cardiologist. It can complicate percutaneous coronary interventions especially in the setting of STEMI and dampens the potential benefits of PPCI. Broadly classified as Reperfusion NR and Interventional NR, mechanism is multifactorial. The basic underlying culprit is microvascular obstruction either secondary to distal embolization, intravascular plugging, or ischemic reperfusion injury. Coronary angiogram is an easy, readily available, and essential modality to diagnose no-reflow, but the gold standard is gadolinium-enhanced cardiovascular magnetic resonance imaging. Preventive strategies for NR should be integral part of prePCI planning especially in clinical scenario where NR is expected such as STEMI with delayed presentation and high thrombus burden, atherectomy, and SVG PCI. The cornerstone of treatment for NR is local vasodilators and antiplatelet therapy to ameliorate vasospasm and thromboembolism respectively, and different combinations of the two should be used in no specific order to achieve reversal of NR. NR phenomenon is associated with poor short-term and long-term prognosis and every attempt should be made to avoid or reverse it. Therapeutic hypothermia, hyperoxemic reperfusion therapy, targeted anti-inflammatory approach, and cellular approach appear proising but further research is mandatory.
求助全文
通过发布文献求助,成功后即可免费获取论文全文。 去求助
来源期刊
自引率
0.00%
发文量
0
审稿时长
11 weeks
期刊最新文献
Right Heart Catheterization-Revisited Assessment of Non-Alcoholic Fatty Liver Disease as Risk Factor for Cardiovascular Disease Relationship between Serum Sex Hormones and Coronary Artery Disease in Premenopausal Women – A Missing Link? A Rare Case of Postpartum Native Tricuspid Valve Infective Endocarditis with Septic Pulmonary Embolization Gender Specific Difference and Clinical Spectrum of COVID-19 Patients Admitted in Tertiary Care Hospital of Northern India
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
已复制链接
已复制链接
快去分享给好友吧!
我知道了
×
扫码分享
扫码分享
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1