PCI complications: abrupt closure: Difference between revisions
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'''Editors-In-Chief''': Alexandra Almonacid M.D. [mailto:aalmonacid@partners.org] | '''Editors-In-Chief''': Alexandra Almonacid M.D. [mailto:aalmonacid@partners.org], Jeffrey J. popma M.D. [mailto:jpopma@partners.org] | ||
==Overview== | |||
Abrupt closure during coronary intervention is defined as an abrupt cessation of coronary flow to TIMI 0 or 1. | Abrupt closure during coronary intervention is defined as an abrupt cessation of coronary flow to TIMI 0 or 1. | ||
==Abrupt Closure== | |||
==Incidence== | ===Incidence=== | ||
Occurs during 3-5% of balloon angioplasty procedures. Its incidence has been markedly reduced with the availability of coronary stents (1). | Occurs during 3-5% of balloon angioplasty procedures. Its incidence has been markedly reduced with the availability of coronary stents (1). | ||
==Etiology== | ===Etiology=== | ||
Abrupt closure may be due to coronary dissection, embolization, or thrombus formation within the vessel. | Abrupt closure may be due to coronary dissection, embolization, or thrombus formation within the vessel. | ||
===Factors Associated with Abrupt Closure=== | ====Factors Associated with Abrupt Closure==== | ||
*Clinical: unstable angina, female, AMI, chronic renal failure | *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 | *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== | ===Treatment=== | ||
===Stent Use in Abrupt Closure=== | ====Stent Use in Abrupt Closure==== | ||
*Gianturco-Roubin stent improves lumen size and reduced MACE | *Gianturco-Roubin stent improves lumen size and reduced MACE | ||
*PS stent improves outcome: mortality 1.3%, MI 4%, 1% CABG | *PS stent improves outcome: mortality 1.3%, MI 4%, 1% CABG | ||
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*Rx: maintain flow, complete coverage | *Rx: maintain flow, complete coverage | ||
==Prognosis== | ===Prognosis=== | ||
===Factors Predicting Mortality after Abrupt Closure=== | ====Factors Predicting Mortality after Abrupt Closure==== | ||
*% myocardium at risk | *% myocardium at risk | ||
*LM and multivessel disease | *LM and multivessel disease | ||
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*Female gender | *Female gender | ||
*Diabetes | *Diabetes | ||
==References== | |||
{{reflist|2}} | |||
#ref1 PMID 11870931 | #ref1 PMID 11870931 | ||
[[Category:Up-To-Date]] | |||
[[Category:Up-To-Date cardiology]] | |||
[[Category:Cardiology]] | [[Category:Cardiology]] | ||
{{WikiDoc Help Menu}} | {{WikiDoc Help Menu}} | ||
{{WikiDoc Sources}} | {{WikiDoc Sources}} |
Revision as of 18:37, 10 January 2013
Percutaneous coronary intervention Microchapters |
PCI Complications |
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PCI in Specific Patients |
PCI in Specific Lesion Types |
PCI complications: abrupt closure On the Web |
American Roentgen Ray Society Images of PCI complications: abrupt closure |
Directions to Hospitals Treating Percutaneous coronary intervention |
Risk calculators and risk factors for PCI complications: abrupt closure |
Editors-In-Chief: Alexandra Almonacid M.D. [1], Jeffrey J. popma M.D. [2]
Overview
Abrupt closure during coronary intervention is defined as an abrupt cessation of coronary flow to TIMI 0 or 1.
Abrupt Closure
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
References
- ref1 PMID 11870931