{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T17:50:14Z","timestamp":1791395414571,"version":"4.3.3"},"reference-count":38,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T00:00:00Z","timestamp":1767744000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T00:00:00Z","timestamp":1767744000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cathet Cardio Intervent"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Coronary slow flow (SF) and no\u2010reflow (NR) are clinically significant complications of percutaneous coronary intervention (PCI), particularly in ST\u2010segment elevation myocardial infarction (STEMI) and saphenous vein graft (SVG) interventions. Angiographically defined as impaired myocardial perfusion despite restored epicardial patency, SF\/NR results from microvascular dysfunction driven by distal embolization, ischemia\u2013reperfusion injury, microvascular spasm, capillary plugging and emerging molecular mechanisms such as endothelial glycocalyx degradation and microRNA\u2010mediated inflammatory pathways. These processes contribute to larger infarct size, maladaptive remodeling, and increased mortality. Advanced intracoronary imaging enables lesion\u2010level risk stratification by identifying features such as lipid\u2010rich cores, thin\u2010cap fibroatheromas, positive remodeling, and thrombus. Image\u2010guided strategies, incorporating deferred stenting, selective aspiration, and tailored lesion preparation, can mitigate distal embolization. Risk stratification models (e.g., PAMI score) and recognition of sex\u2010 and race\u2010based disparities further refine procedural planning. Cost, accessibility, and emerging AI\u2010driven automated plaque characterization tools are important considerations for wider implementation. Preventive measures emphasize systemic optimization, adequate anticoagulation, high\u2010intensity statin pretreatment informed by precision dosing, dual antiplatelet therapy, and refined device techniques in thrombus\u2010rich or calcified lesions. Management requires early recognition, systematic exclusion of mimics such as dissection or epicardial spasm, maintenance of anticoagulation, and rapid stepwise administration of intracoronary microvasculature dilators. Device\u2010based delivery methods offer practical advantages but carry specific risks, including device entrapment or vessel trauma. Adjunctive therapies such as supersaturated oxygen may be considered in refractory cases. A structured, imaging\u2010informed algorithm integrating preventive strategies, pharmacologic escalation, and device\u2010assisted therapy may reduce SF\/NR incidence and improve procedural and long\u2010term outcomes. Future research should validate imaging\u2010guided preventive strategies, standardized rescue protocols, and the role of AI\u2010driven risk assessment in diverse patient populations.<\/jats:p>","DOI":"10.1002\/ccd.70468","type":"journal-article","created":{"date-parts":[[2026,1,8]],"date-time":"2026-01-08T06:28:52Z","timestamp":1767853732000},"page":"1198-1205","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Coronary Slow Flow and No\u2010Reflow During Percutaneous Coronary Intervention: Contemporary Insights Into Imaging\u2010Guided Prediction, Prevention, and Management"],"prefix":"10.1002","volume":"107","author":[{"given":"Bharat","family":"Khialani","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Medicine Tan Tock Seng Hospital, National Healthcare Group Jln Tan Tock Seng Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eran","family":"Sim","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine Tan Tock Seng Hospital, National Healthcare Group Jln Tan Tock Seng Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George","family":"Touma","sequence":"additional","affiliation":[{"name":"Hurstville Private Hospital Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0711-9499","authenticated-orcid":false,"given":"Sarah","family":"Fairley","sequence":"additional","affiliation":[{"name":"Wellington Cardiology Department Wellington Hospital Wellington New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cuneyt","family":"Ada","sequence":"additional","affiliation":[{"name":"Department of Cardiology Macquarie University Hospital Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9346-8221","authenticated-orcid":false,"given":"Bernard","family":"Wong","sequence":"additional","affiliation":[{"name":"Faculty of Medical and Health Sciences, School of Medicine University of Auckland Auckland New Zealand"},{"name":"Department of Cardiology North Shore Hospital Auckland New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,1,7]]},"reference":[{"issue":"7","key":"e_1_2_13_2_1","first-page":"1356","article-title":"Coronary Slow Flow Phenomenon: Insights Into Pathophysiology and Clinical Implications","volume":"44","author":"Gibson C. 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