|
|
| (35 intermediate revisions by 4 users not shown) |
| Line 1: |
Line 1: |
| {{SI}}
| | #redirect[[Abrupt closure]] |
| | |
| '''Editors-In-Chief''': Alexandra Almonacid M.D. [mailto:aalmonacid@partners.org] and Jeffrey J. popma M.D. [mailto:jpopma@partners.org]
| |
| | |
| ==Definition==
| |
| | |
| Abrupt closure during coronary intervention is defined as an abrupt cessation of coronary flow to TIMI 0 or 1.
| |
| | |
| ----
| |
| | |
| ==Incidence==
| |
| Occurs during 3-5% of balloon angioplasty procedures. Its incidence has been markedly reduced with the availability of coronary stents (1).
| |
| | |
| ----
| |
| | |
| ==Etiology==
| |
| Abrupt closure may be due to coronary dissection, embolization, or thrombus formation within the vessel. | |
| | |
| ===Factors Associated with Abrupt Closure===
| |
| *Clinical: unstable angina, female, AMI, chronic renal failure
| |
| *Angiographic: Intraluminal thrombus, ACC/AHA score, multivessel disease, long lesions, >45 degree angulation, branch points, proximal tortuosity, ostial RCA, degenerated SVGs, prestenosis >90%, intimal dissections
| |
| | |
| ==Treatment==
| |
| ===Stent Use in Abrupt Closure===
| |
| *Gianturco-Roubin stent improves lumen size and reduced MACE
| |
| *PS stent improves outcome: mortality 1.3%, MI 4%, 1% CABG
| |
| *ACS Multi-Link: mortality 1.4%, MI 2.9%
| |
| *Mostly associated with subacute stent thrombosis
| |
| *Rx: maintain flow, complete coverage
| |
| | |
| ==Prognosis==
| |
| ===Factors Predicting Mortality after Abrupt Closure===
| |
| *% myocardium at risk
| |
| *LM and multivessel disease
| |
| *CHF, UAP
| |
| *Target vessels supplies collaterals
| |
| *> age 65 years
| |
| *Chronic renal failure
| |
| *Female gender
| |
| *Diabetes
| |
| | |
| #ref1 PMID 11870931
| |
| | |
| | |
| [[Category:Cardiology]]
| |
| {{WikiDoc Help Menu}}
| |
| {{WikiDoc Sources}}
| |