Low-dose fibrinolysis during primary percutaneous intervention for preventing no-reflow: stepping back to move forward?

EuroIntervention 2022;18:452-455. DOI: 10.4244/EIJ-D-22-00250

Francesco Pelliccia
Francesco Pelliccia1, MD, PhD; Giampaolo Niccoli2, MD, PhD
1. Department of Cardiovascular Sciences, Sapienza University, Rome, Italy; 2. Department of Cardiology, University of Parma, Parma, Italy
Primary percutaneous coronary intervention (PCI) is the gold standard of treatment for ST-elevation acute myocardial infarction (STEMI)1. Although primary PCI restores optimal blood flow in the infarct-related artery (IRA), a sizeable proportion of patients experience the so-called “no-reflow” phenomenon, i.e., they continue to exhibit overt impairment of myocardial reperfusion despite successful opening of the IRA1. No-reflow occurs due to microvascular obstruction (MVO) and has a variable prevalence ranging from 5% up to 60%1. The underlying mechanisms of myocardial injury and MVO are multiple and interacting (Figure 1)1. Above all, an important determinant of MVO is distal embolisation of thrombus debris ...

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