“No-reflow” phenomenon in acute ischemic stroke

• Published in: Journal of cerebral blood flow and metabolism Vol. 44; no. 1; pp. 19 - 37
• Main Authors: Zhang, Yang, Jiang, Miaowen, Gao, Yuan, Zhao, Wenbo, Wu, Chuanjie, Li, Chuanhui, Li, Ming, Wu, Di, Wang, Wu, Ji, Xunming
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01.01.2024
• Subjects: Animals; Humans; Ischemic Stroke; No-Reflow Phenomenon - diagnostic imaging; No-Reflow Phenomenon - therapy; Review; Stroke - diagnostic imaging; Stroke - therapy; Thrombectomy; Treatment Outcome; No-reflow; recanalization; poor perfusion; acute ischemic stroke; neurovascular unit
• ISSN: 0271-678X; 1559-7016; 1559-7016
• DOI: 10.1177/0271678X231208476

Acute ischemic stroke (AIS) afflicts millions of individuals worldwide. Despite the advancements in thrombolysis and thrombectomy facilitating proximal large artery recanalization, the resultant distal hypoperfusion, referred to “no-reflow” phenomenon, often impedes the neurological function restoration in patients. Over half a century of scientific inquiry has validated the existence of cerebral “no-reflow” in both animal models and human subjects. Furthermore, the correlation between “no-reflow” and adverse clinical outcomes underscores the necessity to address this phenomenon as a pivotal strategy for enhancing AIS prognoses. The underlying mechanisms of “no-reflow” are multifaceted, encompassing the formation of microemboli, microvascular compression and contraction. Moreover, a myriad of complex mechanisms warrant further investigation. Insights gleaned from mechanistic exploration have prompted advancements in “no-reflow” treatment, including microthrombosis therapy, which has demonstrated clinical efficacy in improving patient prognoses. The stagnation in current “no-reflow” diagnostic methods imposes limitations on the timely application of combined therapy on “no-reflow” post-recanalization. This narrative review will traverse the historical journey of the “no-reflow” phenomenon, delve into its underpinnings in AIS, and elucidate potential therapeutic and diagnostic strategies. Our aim is to equip readers with a swift comprehension of the “no-reflow” phenomenon and highlight critical points for future research endeavors.