PCI complications: abrupt closure

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Editors-In-Chief: Alexandra Almonacid M.D. [1] and Jeffrey J. popma M.D. [2]

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).

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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

1. ref1 PMID 11870931