Mẹo mực để phòng ngừa và xử trí hiện tượng không có dòng chảy trong lòng mạch vành

Thomas Tu, MD FACC FSCAI Vietnam National Congress of Cardiology Da Nang, Vietnam October 12, 2014 No Reflow  Definition  Mechanisms  Clinical consequences  Prevention  Treatment No Reflow - Definition  Inability to reperfuse regions of myocardium despite correction of epicardial stenosis/occlusion  Primarily a microvascular problem Predictors of No Reflow  Large thrombus burden  Soft necrotic plaque  Thin fibrous cap  Slow initial flow  Late reperfusion  SVG lesion  Acute coronary syndrome presentation Consequences of No Reflow  Myocardial infarction (sub-endocardial or transmural)  Abrupt closure  Arrhythmias  Increased mortality Prevention of No Reflow  Antiplatelet therapy  Anticoagulation  Vasodilator therapy  Thrombectomy  Embolic protection Management of No Reflow  Maintain normal perfusion pressure and rhythm  Exclude mechanical causes of impaired flow  Dissection  Thrombus  Vasospasm  Optimize anticoagulation (check ACT)  Intracoronary GP IIb/IIIa administration  Vasodilators via distal injection Conclusions  No reflow is a common complication of coronary intervention  Successful opening of the epicardial coronary is not beneficial to the patient without maintaining flow in the microvascular circulation  There are clinical and angiographic factors that can predict occurrence of no reflow  Treatment includes supportive measures, pharmacologic, and mechanical techniques