A. Results from microvascular thrombus formation obstructing forward coronary blood flow
B. Can be reduced by thrombus aspiration
C. Is more likely if a patient presents late after symptom onset for coronary intervention
D. Can potentially be lessened using glycoprotein IIb/IIIa inhibitors
E. All of the above
When coronary angiography is performed late after symptom onset during STEMI, there is a risk of “no-reflow” or “microvascular obstruction”. This results in significant decrease in forward blood flow in the coronary circulation despite the major vessel remaining patent. Since the distal, smaller vascular bed is occluded with thrombus, there is no circulatory channel for the blood to leave the coronary arteries. Catheter-based thrombus aspiration (thrombectomy) can help prevent no-reflow, although data is limited. More aggressive use of glycoprotein IIb/IIIa inhibitors may help as well, although again data is limited. The presence of no-reflow does predict worse outcomes after STEMI.