Reperfusion Failure in Interventional Cardiology: Mechanisms, Prevention, and Treatment of Coronary No-Reflow

Coronary no-reflow remains a major obstacle in interventional cardiology, occurring in up to one third of primary percutaneous coronary interventions (PCI) for ST-segment elevation myocardial infarction (STEMI). Although epicardial flow is restored, microvascular obstruction limits myocardial reperfusion, increasing infarct size and mortality. This phenomenon arises from a combination of distal embolisation, endothelial and reperfusion injury, vasospasm, and inflammation. Recent studies have highlighted new mechanisms involving neutrophil extracellular traps, platelet–leukocyte aggregates, and pericyte dysfunction. Yet, despite decades of investigation, no strategy has gained consistent clinical approval, reinforcing the need for targeted, evidence-based interventions.This Research Topic aims to advance the understanding and improve management of coronary no-reflow as a peri-procedural event in PCI. It seeks to elucidate the molecular and cellular triggers of reperfusion failure, identify early diagnostic signals, and assess both pharmacological and procedural interventions that can prevent or reverse microvascular injury. By combining clinical, translational, and mechanistic insights, this Topic encourages new solutions that translate into improved myocardial recovery and patient outcomes.To further explore these mechanisms and therapies, we welcome articles addressing, but not limited to, the following themes:o Immunothrombotic and cellular mechanisms driving no-reflow.o Diagnostic and biomarker tools for risk prediction and early detection.o Pharmacological strategies: vasodilators, glycoprotein IIb/IIIa inhibitors, thrombolytics, and anti-inflammatory agents.o Procedural and device-based approaches: thrombus aspiration, distal protection, deferred stenting, and atherectomy optimization.o Conditioning and metabolic strategies for reperfusion protection.o Predictive modelling and imaging-based risk assessment.o Clinical implications in high-risk subgroups including elderly, shock, graft PCI, and chronic occlusion cases.**Topic Editor Dr. Nikolaos Stalikas is receiving a research grant from the Hellenic Society of Cardiology. Topic editors: Nikos Stalikas, Tatyana Storozhenko Source: https://www.frontiersin.org/research-topics/82738/reperfusion-failure-in-interventional-cardiology-mechanisms-prevention-and-treatment-of-coronary-no-reflow