Primary percutaneous coronary intervention: devices to prevent no-reflow phenomenon

Primary percutaneous coronary intervention, where available, has become the therapy of choice in myocardial reperfusion during ST-elevation myocardial infarction. However, in a significant proportion of patients, owing to a high thrombus burden, myocardial perfusion is not fully achieved in the epicardial vessel. This phenomenon has been attributed predominantly to the distal embolization of thrombus particles and atherosclerotic plaque debris resulting in an association with poorer shortand long-term outcomes, including heart failure and death. Pharmacological measures, such as adequate antiplatelet therapy, glycoprotein IIb/IIIa antagonists and coronary vasodilators, have been employed with the aim of reducing this phenomenon, with limited success. This clinical need has led to the development of devices dedicated to evacuating or trapping thrombus during intervention to reduce the risk of distal embolization during percutaneous coronary intervention. Controversies regarding the benefits that have been achieved with the use of these devices and additional novel approaches, such as the mesh covered stent, will be discussed in this article.