Key result
Direct stenting and GP IIb/IIIa inhibitors may reduce distal embolism and no-reflow during STEMI PCI.
Why the study?
The pathogenesis of the no-reflow or slow-reflow phenomenon following PCI in patients with STEMI requires continuous and in-depth study.
This review highlights that glycoprotein IIb/IIIa inhibitors and direct stenting are key strategies for preventing distal embolism and the no-reflow phenomenon during PCI in STEMI patients.
May inform no-reflow prevention strategies in STEMI PCI; leaves open randomized confirmation before practice change.
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.
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Sazanov et al. (2024) conducted a review in ST-segment elevation acute coronary syndrome. Endovascular prevention of distal embolism was evaluated. Direct stenting without pre-dilatation and intravenous GP IIb/IIIa inhibitors are proposed to reduce the risk of distal embolism and no-reflow phenomenon during PCI in STEMI patients.
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