Advances in Pathophysiology and Novel Therapeutic Strategies for Coronary No-Reflow Phenomenon
Coronary no-reflow (CNR) is the failure of blood to reperfuse ischemic myocardial tissue after restoration of the vasculature. CNR poses a significant clinical challenge in the treatment of patients with ST-segment elevation myocardial infarction (STEMI), as it increases mortality and the risk of ma...
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| Format: | Article |
| Language: | English |
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MDPI AG
2025-07-01
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| Series: | Biomedicines |
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| Online Access: | https://www.mdpi.com/2227-9059/13/7/1716 |
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| author | Hubert Borzuta Wiktor Kociemba Oliwia Bochenek Monika Jarowicz Agnieszka Wsół |
| author_facet | Hubert Borzuta Wiktor Kociemba Oliwia Bochenek Monika Jarowicz Agnieszka Wsół |
| author_sort | Hubert Borzuta |
| collection | DOAJ |
| description | Coronary no-reflow (CNR) is the failure of blood to reperfuse ischemic myocardial tissue after restoration of the vasculature. CNR poses a significant clinical challenge in the treatment of patients with ST-segment elevation myocardial infarction (STEMI), as it increases mortality and the risk of major adverse cardiac events (MACEs). Myocardial ischemia with subsequent reperfusion results in severe damage to the cardiac microcirculation. The pathophysiological causes of CNR include cardiomyocyte vulnerability, capillary and endothelial damage, leukocyte activation, reactive oxygen species (ROS) production, and changes in microRNA profiles and related gene expression. The impact of percutaneous coronary intervention (PCI) on the occurrence of CNR cannot be overlooked, as it can provoke distal atherothrombotic embolization. Current standards of pharmacological therapy for CNR are confined to intracoronary vasodilators and antiplatelet agents. As our understanding of the pathogenesis of the CNR phenomenon improves, opportunities emerge for developing novel therapeutic strategies. The following literature review provides an overview of the pathophysiology of the no-reflow phenomenon (based on animal and preclinical studies), contemporary treatment trends, and current therapeutic approaches. |
| format | Article |
| id | doaj-art-4e90db7111254c69a06ca3608741c8dd |
| institution | Kabale University |
| issn | 2227-9059 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Biomedicines |
| spelling | doaj-art-4e90db7111254c69a06ca3608741c8dd2025-08-20T03:36:34ZengMDPI AGBiomedicines2227-90592025-07-01137171610.3390/biomedicines13071716Advances in Pathophysiology and Novel Therapeutic Strategies for Coronary No-Reflow PhenomenonHubert Borzuta0Wiktor Kociemba1Oliwia Bochenek2Monika Jarowicz3Agnieszka Wsół4Chair and Department of Experimental and Clinical Physiology, Laboratory of Centre for Preclinical Research, Medical University of Warsaw, Banacha 1b, 02-097 Warsaw, PolandChair and Department of Experimental and Clinical Physiology, Laboratory of Centre for Preclinical Research, Medical University of Warsaw, Banacha 1b, 02-097 Warsaw, PolandMiędzylesie Specialist Hospital in Warsaw, Bursztynowa 2, 04-749 Warsaw, PolandChair and Department of Experimental and Clinical Physiology, Laboratory of Centre for Preclinical Research, Medical University of Warsaw, Banacha 1b, 02-097 Warsaw, PolandChair and Department of Experimental and Clinical Physiology, Laboratory of Centre for Preclinical Research, Medical University of Warsaw, Banacha 1b, 02-097 Warsaw, PolandCoronary no-reflow (CNR) is the failure of blood to reperfuse ischemic myocardial tissue after restoration of the vasculature. CNR poses a significant clinical challenge in the treatment of patients with ST-segment elevation myocardial infarction (STEMI), as it increases mortality and the risk of major adverse cardiac events (MACEs). Myocardial ischemia with subsequent reperfusion results in severe damage to the cardiac microcirculation. The pathophysiological causes of CNR include cardiomyocyte vulnerability, capillary and endothelial damage, leukocyte activation, reactive oxygen species (ROS) production, and changes in microRNA profiles and related gene expression. The impact of percutaneous coronary intervention (PCI) on the occurrence of CNR cannot be overlooked, as it can provoke distal atherothrombotic embolization. Current standards of pharmacological therapy for CNR are confined to intracoronary vasodilators and antiplatelet agents. As our understanding of the pathogenesis of the CNR phenomenon improves, opportunities emerge for developing novel therapeutic strategies. The following literature review provides an overview of the pathophysiology of the no-reflow phenomenon (based on animal and preclinical studies), contemporary treatment trends, and current therapeutic approaches.https://www.mdpi.com/2227-9059/13/7/1716coronary no-reflowmyocardial infarctionanimal modelspathophysiologyischemia/reperfusion injurymicrovascular obstruction |
| spellingShingle | Hubert Borzuta Wiktor Kociemba Oliwia Bochenek Monika Jarowicz Agnieszka Wsół Advances in Pathophysiology and Novel Therapeutic Strategies for Coronary No-Reflow Phenomenon Biomedicines coronary no-reflow myocardial infarction animal models pathophysiology ischemia/reperfusion injury microvascular obstruction |
| title | Advances in Pathophysiology and Novel Therapeutic Strategies for Coronary No-Reflow Phenomenon |
| title_full | Advances in Pathophysiology and Novel Therapeutic Strategies for Coronary No-Reflow Phenomenon |
| title_fullStr | Advances in Pathophysiology and Novel Therapeutic Strategies for Coronary No-Reflow Phenomenon |
| title_full_unstemmed | Advances in Pathophysiology and Novel Therapeutic Strategies for Coronary No-Reflow Phenomenon |
| title_short | Advances in Pathophysiology and Novel Therapeutic Strategies for Coronary No-Reflow Phenomenon |
| title_sort | advances in pathophysiology and novel therapeutic strategies for coronary no reflow phenomenon |
| topic | coronary no-reflow myocardial infarction animal models pathophysiology ischemia/reperfusion injury microvascular obstruction |
| url | https://www.mdpi.com/2227-9059/13/7/1716 |
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