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Morphological Features Seen on Intravascular Ultrasound Predict No-Reflow

Certain morphological features of intravascular lesions appear to be predictors for the "no-reflow" phenomenon--failure to restore normal myocardial blood flow--following balloon angioplasty or stenting.

In particular, large vessels with lipid pool-like image appear to be a high risk for no reflow after primary intervention for acute myocardial infarction. In addition, plaque content may play a role in damage to the microcirculation following intervention, say researchers at Baba Memorial Hospital, Sakai, and Osaka City University, Osaka, Japan.

They studied 100 consecutive patients with acute myocardial infarction who underwent pre-intervention intravascular ultrasound and were successfully recanalized with primary balloon angioplasty or stenting. The ultrasound was performed again to exclude any mechanical vessel obstruction in cases of thrombolysis among patients with flow grade zero, one or two, in the absence of angiographic stenosis.

Angiographic no-reflow was seen in 13 patients (13 percent). Features that correlated with no-reflow included the following: hypercholesterolemia; fissure and dissection; lipid pool-like image; lesion; and reference external elastic membrane cross-sectional area. Further analysis showed that lipid pool-like image and lesion elastic membrane cross-sectional area are independent predictive factors of no-reflow.

"The no-reflow phenomenon is associated with poor functional and clinical outcomes for patients with acute myocardial infarction," the researchers say. "In the era of primary intervention, accurately identifying lesions at high risk of no-reflow is of crucial importance."
Circulation. 2002;105:2148. "No-Reflow Phenomenon and Lesion Morphology in Patients With Acute Myocardial Infarction"

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