Pharmacoinvasiv e strategy: no-reflow phenomenon following thrombolytic therapy (literature review)

Objective. To study the impact of a pharmacoinvasive strategy on the incidence of coronary thrombosis and the no-reflow phenomenon in acute myocardial infarction.
Objectives. The main objectives include the analysis of no-reflow mechanisms, evaluation of the effectiveness of prehospital thrombolytic therapy, and comparison of the results of percutaneous coronary intervention using pharmacoinvasive techniques and primary percutaneous coronary intervention without prior preparation.
Materials and Methods. An analysis of current scientific literature on the no-reflow phenomenon and pharmacoinvasive therapy in open sources (PubMed, Scopus, eLIBRARY) for 2013–2024 was conducted. Randomized clinical trials, meta-analyses, and observational studies on the impact of this technique on complications in acute myocardial infarction with ST-segment elevation were examined. The focus was on articles from the last five years (2019–2024), including key indicators of coronary blood flow, microcirculation, and disease outcomes. Data from the Primorsky region (n=124) on the results of combined thrombolysis and angioplasty were additionally analyzed.
Results. The no-reflow phenomenon is manifested by a disruption of the blood supply to small vessels after the elimination of a large thrombosis and is caused by microembolization mechanisms, ischemic injury, inflammatory reactions, and vascular spasms. Diagnosis is based on angiography, microvascular resistance index and imaging methods: magnetic resonance imaging and ultrasound diagnostics. Risk factors include late hospitalization, large infarct size, and the presence of comorbidities. A pharmacoinvasive strategy effectively prevents no-reflow thanks to early thrombolytic therapy, which reduces thrombotic volume and improves tissue perfusion and is associated with better myocardial function and less necrosis. If signs of microcirculatory impairment persist, antithrombotic agents, thrombus removal, delayed stenting, and vasodilators are used. Prevention and correction of no-reflow require a comprehensive approach and thorough diagnostics.
Conclusion. The no-reflow phenomenon worsens the treatment outcomes of acute myocardial infarction, therefore, a pharmacoinvasive strategy including thrombolysis and antithrombotic therapy should be used to quickly restore blood flow and reduce myocardial damage. The identified risk factors will allow physicians to assess the likelihood of this phenomenon occurring in a given patient and plan prevention and treatment in advance. Furthermore, the impact of innovative diagnostic methods and therapeutic approaches (robotic systems, intracardiac devices) on preventing no-reflow is further studied, as is the need for further clinical trials to evaluate optimal drug combinations and timing of administration.

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