No Reflow Phenomenon

Primary objective of the study is to evaluate the impact of adenosine pre-medication on incidence of slow flow/no-reflow after primary percutaneous coronary intervention.

Introduction: Endovascular thrombectomy (EVT) is an effective treatment strategy to mitigate the ischemic tissue damage caused by the acute cerebral large-vessel occlusion. However, in clinical practice, nearly half of the patients do not experience adequate neurological improvement despite successful recanalization - a phenomenon termed reperfusion failure or clinically ineffective reperfusion. Given the clinical relevance of this phenomenon and the absence of a standardized imaging diagnostic method to identify it, our project aims to explore the potential role of blood oxygenation-level dependent cerebrovascular reactivity (BOLD-CVR) as novel imaging biomarker for studying reperfusion failure. Study population: Adult patients with acute ischemic stroke of the ICA, MCA or with tandem occlusion who have undergone a successful recanalization, described as mTICI score ≥2b. Objective(s): Primary objective: to longitudinally observe blood flow changes derived from BOLD-CVR imaging following successful endovascular thrombectomy in patients with large-vessel occlusion acute ischemic stroke (LVO-AIS) during the early post-treatment phase and assess their association with clinical outcome 90 days post-EVT. Secondary objective: to compare BOLD-CVR findings with those obtained from the clinical standard dynamic susceptibility contrast (DSC) MR perfusion imaging acquired in the same examination session as well as other imaging techniques included in the standard post-treatment imaging protocol at our institution. Outcomes: Clinical outcomes: * 90-day functional outcome. * Functional outcome at hospital discharge. * Neurological deterioration during hospitalization. * Radiologically confirmed haemorrhagic transformation within the reperfused tissue. * Radiologically confirmed infarct lesion progression within the reperfused tissue. * Additionally, DSC MR perfusion imaging parameters and other standard hemodynamic imaging parameters will be considered as imaging outcomes Study design: Single-center prospective observational cohort study Measurements and procedures: Included patients will undergo a total of 3 BOLD-CVR examinations: 72 hours, 7 days, and 90 days after EVT. Participation in the final examination will mark the end of the subject's involvement in the study. Clinical outcomes will be prospectively collected as per established institutional patient management protocols: during hospitalization, at discharge, and at the cerebrovascular outpatient clinic at 3 months. Number of Participants: Target sample size: 100 patients Given the observational study design and exploratory nature of this project, no sample size calculation can be performed. The provided target sample size (N = 100) has been estimated considering the inclusion of as many consecutive subjects as possible. Study period: 2.5 years The investigators aim to enroll a target sample size of 100 patients over a period of 2.5 years. This translates to an inclusion of 3-4 patients per month, with the last three months allocated for the follow-up of the last included patients. Study Centre: Clinical Neuroscience Center, Department of Neurosurgery, University Hospital Zurich Statistical Considerations: The association between BOLD-CVR findings and clinical outcomes will be investigated using regression analyses.

The goal of this clinical trial is to learn if drug Rivaroxaban works to improve slow flow in STEMI patients after PCI in adults. It will also learn about the safety of drug Rivaroxaban. The main questions it aims to answer are: Does drug Rivaroxaban Reduce the Corrected TIMI Frame Count (cTFC) in 1 Week After PCI ? Researchers will compare Combination therapy with rivaroxaban (2.5 mg administered twice daily), aspirin (100 mg administered daily), and clopidogrel (75 mg administered daily) to Dual Antiplatelet Therapy to see if drug Combination therapy with rivaroxaban, aspirin works to treat Slow Flow in STEMI Patients After PCI. Participants will: Take drug Combination therapy with rivaroxaban (2.5 mg administered twice daily), aspirin (100 mg administered daily), and clopidogrel (75 mg administered daily) or Dual Antiplatelet Therapy every day for 1 months. Visit the clinic in 7 days、30 days and 365 days for checkups and tests.

To evaluate the diagnostic value of the selected emerging biomarkers in predicting the no-reflow phenomenon among patients presenting with STEMI undergoing primary PCI. These biomarkers include: HbA1c/C-peptide ratio Albumin-bilirubin (ALBI) score. Neutrophil/HDL ratio

The aim of this work is to study the role of intracoronary adrenaline administration as a preventive tool for no reflow in patients undergoing primary PCI. The main question it aims to answer is: Do prohylcatic intrcoronary adrenaline reduce the incidence of no reflow without increaing risk of arrhythmia in primary PCI? The procedure will be performed by expert operators. All patients will receive the guidelines-directed recommendations of intervention of STEMI patients. Study group wil receive Intracoronary 10 mcg adrenaline via the guiding catheter after restoration of epicardial coronary flow of the culprit vessel and achievement of TIMI I flow either after wiring and/or passage of a deflated balloon and/or PTCA with a small balloon, and/or use of thrombus aspiration and before stenting. All steps in the Cath-lab will be described in detail: The primary end points will be improvement in coronary flow, as assessed by TIMI (Thrombolysis in Myocardial Infarction) flow, and myocardial blush. Secondary end points will be in-hospital mortality and major adverse cardiac events.

The aim of this study was to determine the effect of intra-coronary administration of nicorandil on the prevention of lowering of coronary blood flow for high-risk plaque lesions defined as the high value of lipid core burden index in patients with coronary artery disease who require stent treatment.

Angiographic no-reflow during primary PCI procedures occurs at relatively high rate (25%) and is associated with worsening of long term morbidity and mortality. The exact mechanism of no-reflow is not fully understood, yet it is believed to be multifactorial including microvascular plugging with activated platelets and thrombotic debris in addition to the microvascular dysfunction from the ischaemia-reperfusion injury. Despite a theoretical advantage of glycoprotein IIb/IIIa inhibitors (GPi) (like; Tirofiban) to suppress the intense platelets' activation/reaction; their use did not lead to a significant net benefit, because it was opposed by increased risk of bleeding. However, the bleeding that plagued GPi use was predominantly related to vascular access in the era femoral approach was the default. Moreover, there are some recent data suggesting that small intracoronary bolus of GPi was non-inferior to intravenous bolus-infusion dose with less bleeding events. This study plans to assess upfront premedication with small doses of GPi + Nitroglycerin ± Verapamil, with staged restoration of flow (repeated balloon inflation) to reduce angiographic no-reflow and CMR assessed microvascular occlusion (MVO).