Neurology: No-reflow phenomenon after successful thrombectomy, a new target for therapy?

Despite timely and successful endovascular reperfusion therapy , a substantial proportion of patients with acute ischemic stroke due to large vessel occlusion have poor functional outcomes

Tissue reperfusion proved to be a more important determinant of clinical outcomes than arterial recanalization

Despite compelling preclinical evidence, the existence of no-reflow in the human brain remains controversial

To explore the uncertainty of stroke no-reflow in humans, Felix C.

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No-reflow areas were present in 33 of 130 patients (25.

The authors concluded that cerebral no-reflow is common in humans and can be detected in the clinic by its characteristic perfusion imaging, and that no-reflow is associated with post-treatment complications and disability or death

Translator's Note:

For the mechanisms of pericyte contraction and neutrophil blockage without reflow, administration of pericyte relaxants such as adenosine and the oxygen radical scavenger N-tert-butyl-a-benzonitrone, as well as depletion of neutrophils by anti-Ly6G antibodies Granulocytes to reduce neutrophil blockage in capillaries have also been shown to restore capillary blood flow, prevent no-reflow phenomena, and reduce infarct size and neurological deficits in animal models

In addition, for the mechanism of no-reflow microthrombosis, thrombolytic agents can be administered immediately after successful endovascular treatment (recent studies have proven effective), and early antithrombotics such as infusion of tirofiban or anticoagulation immediately after surgery can be performed
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These ideas need further research to confirm
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Original source:

Prevalence and Significance of Impaired Microvascular Tissue Reperfusion Despite Macrovascular Angiographic Reperfusion (No-Reflow) .
Neurology.
2022 Feb 22;98(8):e790-e801.
doi: 10.
1212/WNL.
0000000000013210.
Epub 2021 Dec 14.