No-reflow phenomenon in stroke patients: a systematic literature review and meta-analysis of clinical data.

Mujanovic, Adnan; Ng, Felix Chun Fai; Meinel, Thomas; Dobrocky, Thomas; Piechowiak, Eike I; Kurmann, Christoph; Seiffge, David J.; Wegener, Susanne; Wiest, Roland; Meyer, Lukas; Fiehler, Jens; Olivot, Jean-Marc; Ribo, Marc; Nguyen, Thanh N; Gralla, Jan; Campbell, Bruce; Fischer, Urs; Kaesmacher, Johannes (2024). No-reflow phenomenon in stroke patients: a systematic literature review and meta-analysis of clinical data. International journal of stroke, 19(1), pp. 58-67. SAGE 10.1177/17474930231180434

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BackgroundThe no-reflow phenomenon refers to the absence of microvascular reperfusion despite macrovascular reperfusion.AimThe aim of this analysis was to summarize the available clinical evidence on no-reflow in patients with acute ischemic stroke.MethodsA systematic literature review and a meta-analysis of clinical data on definition, rates and impact of the no-reflow phenomenon after reperfusion therapy was carried out. A predefined research strategy was formulated according to the PICO model and was used to screen for articles in PubMed, MEDLINE and Embase up to September 8, 2022. Whenever possible, quantitative data were summarized using a random-effects model.ResultsThirteen studies with a total of 719 patients were included in the final analysis. Most studies (n=10/13) used variations of the Thrombolysis in Cerebral Infarction scale to evaluate macrovascular reperfusion, whereas microvascular reperfusion and no-reflow were mostly assessed on perfusion maps (n=9/13). In one third of stroke patients with successful macrovascular reperfusion (29%, 95% CI 21-37%) the no-reflow phenomenon was observed. Pooled analysis showed that no-reflow was consistently associated with reduced rates of functional independence (OR 0.21, 95% CI 0.15-0.31).ConclusionThe definition of no-reflow varied substantially across studies but it appears to be a common phenomenon. Some of the no-reflow cases may simply represent remaining vessel occlusions and it remains unclear whether no-reflow is an epiphenomenon of the infarcted parenchyma or causes infarction. Future studies should focus on standardizing the definition of no-reflow with more consistent definitions of successful macrovascular reperfusion and experimental set-ups that could detect the causality of the observed findings.

Item Type:	Journal Article (Original Article)
Division/Institute:	04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic and Interventional Neuroradiology 04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology 04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic, Interventional and Paediatric Radiology
UniBE Contributor:	Meinel, Thomas Raphael, Dobrocky, Tomas, Piechowiak, Eike Immo, Kurmann, Christoph Carmelino, Seiffge, David Julian, Wiest, Roland Gerhard Rudi, Gralla, Jan, Fischer, Urs Martin, Kaesmacher, Johannes
Subjects:	600 Technology > 610 Medicine & health
ISSN:	1747-4949
Publisher:	SAGE
Language:	English
Submitter:	Pubmed Import
Date Deposited:	26 May 2023 15:47
Last Modified:	03 Jan 2024 00:12
Publisher DOI:	10.1177/17474930231180434
PubMed ID:	37231702
Uncontrolled Keywords:	Brain CT scan Ischaemic stroke MRI Reperfusion Stroke Treatment
URI:	https://boris.unibe.ch/id/eprint/182948