Despite the epicardial coronary blood flow was successfully restored of myocardial infarction patients, a significant proportion of patients with myocardial infarction is still suffering from severe microvascular perfusion injury. In addition to aortic dissection, embolism, cramping and stenosis, this reperfusion failure at the microvascular level is a condition known as no-reflow (NR) or microvascular injury. The underlying pathophysiology of microvascular injury is complex and multifactorial and is not fully understood. The presence of myocardial infarction is a serious prognostic sign. Microvascular injury is regarded as independent predictor of death or recurrent myocardial infarction. It is a multi-factorial and individual susceptibility phenomenon and has not yet established a perfect and effective control strategy. For most of the clinical results are not satisfactory, its prevention and treatment strategies to less or avoid the impact of microvascular injury still remain a major challenge so far. This review summarizes the main mechanisms of pathophysiological pathogenesis and current strategies of prevention and treatment.