الفهرس 
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Abstract
SUMMARY AND CONCLUSIONS
Based on a review of the literature, MCE is the gold
standard for the diagnosis of no-reflow, followed by
coronary angiography. One of the best ways to decrease the
incidence of no-reflow is to reduce infarct size by early
revascularization and adequate pharmacological treatment.
Treatment with acetylsalicylic acid, clopidogrel and statins
before PCI reduce periprocedural myocyte damage and
should be prescribed when possible. The use of GP IIb/IIIa
antagonists in acute coronary syndrome provides additional
microvascular protection and improves clinical outcomes.
Various pharmacological interventions and catheter
devices to retrieve embolic materials were proposed, but
until now, none of them have been adopted as the treatment
of choice because of the variable success rates. Distal
embolic protection has not resulted in improved
microvascular flow or function, or reduction of infarct size
or event-free survival. Randomized studies do not support
routine use of thrombectomy devices with primary PCI in
all STEMI patients for the reduction of major adverse
cardiac event rates.
Effective removal of thrombi using the AngioJet
rheolytic thrombectomy system before stenting may reduce
distal embolization of thrombus, which could improve
myocardial perfusion and salvage. Several studies have
shown that postconditioning reduced myocardial infarct size
by 36% and improved myocardial perfusion; however, the
effect of ischemic postconditioning on clinical outcomes
remains to be determined. It is difficult to recommend the
routine use of adenosine or other vasodilators to prevent noreflow
in acute coronary syndrome patients or in other groups
undergoing PCI based on the current available evidence.
However, should no-reflow occur following PCI,
treatment with intracoronary adenosine or verapamil should
be administered because this therapy is inexpensive and safe,
improves flow in the target vessel and may reduce infarct
size. Postconditioning, beta-blockers and angiotensin receptor
blockers are other techniques or pharmacological drugs with
encouraging results, but further large randomized controlled
trials are required to resolve this issue.
In our point of view, the superiority of verapamil
with sodium nitroprusside in achieving better successful
reperfusion criteria as assessed by Echo and angiographic
data (MBG) mostly because in addition to verapamil effect,
sodium nitroprusside was associated with significant
improvements in coronary flow, with an increase being
seen in TIMI flow and myocardial blush grade(MBG).
Also patients with positive family history and
dyslypidemics had a higher affinity to develop no reflow
compared to other patients.