{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T23:47:58Z","timestamp":1790812078111,"version":"4.1.0"},"reference-count":70,"publisher":"MDPI AG","issue":"22","license":[{"start":{"date-parts":[[2025,11,11]],"date-time":"2025-11-11T00:00:00Z","timestamp":1762819200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>The coronary no-reflow phenomenon remains a daunting and unresolved barrier during percutaneous coronary procedures, especially for acute coronary syndrome. Despite successful epicardial artery patency restoration, decreased microvascular perfusion leads to unfavorable outcomes such as ventricular remodeling, progression of heart failure, and increased mortality. This review provides a new, integrative informative perspective by combining multifactorial pathophysiology, which includes systemic inflammation, thrombogenicity, ischemia\u2013reperfusion injury, and distal embolization, with advances in diagnostic imaging, such as cardiac magnetic resonance and computed tomography. Therapeutic options, including antithrombotic regimes, vasodilators, and mechanical adjuncts, are evaluated in the context of developing debates and unmet clinical needs. Importantly, we provide feasible future directions for artificial intelligence-based predictive modeling and targeted microvascular treatments. This comprehensive review fills a significant gap, aiming to inform personalized approaches and improve both short- and long-term outcomes in this high-risk patient population.<\/jats:p>","DOI":"10.3390\/jcm14227976","type":"journal-article","created":{"date-parts":[[2025,11,11]],"date-time":"2025-11-11T08:57:41Z","timestamp":1762851461000},"page":"7976","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["No-Reflow During Coronary Interventions: A Narrative Review"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-1141-9910","authenticated-orcid":false,"given":"Sara","family":"Malakouti","sequence":"first","affiliation":[{"name":"DCB Academy, 20136 Milano, Italy"},{"name":"Cardiovascular Research Group, Fondazione Ricerca e Innovazione Cardiovascolare, 20143 Milano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1767-5966","authenticated-orcid":false,"given":"Ahmed","family":"Hashim","sequence":"additional","affiliation":[{"name":"DCB Academy, 20136 Milano, Italy"},{"name":"Cardiovascular Medicine Department, Faculty of Medicine, Ain Shams University, Cairo 1181, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6543-7567","authenticated-orcid":false,"given":"Marco","family":"Frazzetto","sequence":"additional","affiliation":[{"name":"DCB Academy, 20136 Milano, Italy"},{"name":"Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5808-7810","authenticated-orcid":false,"given":"Bernardo","family":"Cortese","sequence":"additional","affiliation":[{"name":"DCB Academy, 20136 Milano, Italy"},{"name":"Cardiovascular Research Group, Fondazione Ricerca e Innovazione Cardiovascolare, 20143 Milano, Italy"},{"name":"Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,11,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1093\/eurheartj\/ehx393","article-title":"2017 ESC Guidelines for the Management of Acute Myocardial Infarction in Patients Presenting with ST-Segment Elevation","volume":"39","author":"Ibanez","year":"2018","journal-title":"Eur. 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