Coronary artery dissections, perforations, and the no-reflow phenomenon

Adriano Caixeta, Luiz Fernando Ybarra, Azeem Latib, Flavio Airoldi, Roxana Mehran, George D. Dangas

Research output: Chapter in Book/Report/Conference proceedingChapterpeer-review

2 Scopus citations


Coronary dissection, perforation, and the no-reflow phenomenon are some of the most dreaded complications occurring in the catheterization laboratory and have been associated with a high rate of major adverse outcomes. This chapter discusses the risk factors, recognition, and contemporary approach to managing peri-procedural complications related to percutaneous coronary intervention (PCI). Ischemic complications in the current era usually occur as manifestations of edge dissections after metallic stent or bioresorbable vascular scaffold (BVS) implantation, which can predispose to device thrombosis. Intramural hematoma is a variant of dissection. By intracoronary ultrasound (IVUS) or optical coherence tomography (OCT), intramural hematomas are typically crescent-shaped, with straightening of the internal elastic membrane. For coronary perforation, the treatment strategy depends on the type of vessel and the location of the injury. Persistent no-reflow has important prognostic implications and has been associated with unfavorable clinical outcomes.

Original languageEnglish
Title of host publicationInterventional Cardiology
Subtitle of host publicationPrinciples and Practice
Number of pages19
ISBN (Electronic)9781118983652
ISBN (Print)9781118976036
StatePublished - 21 Nov 2016


  • Bioresorbable vascular scaffold system
  • Catheterization laboratory
  • Coronary artery dissection
  • Coronary perforation
  • Intracoronary ultrasound
  • Ischemic complications
  • No reflow phenomenon
  • Optical coherence tomography
  • Percutaneous coronary intervention


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