PCI complications: abrupt closure
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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.
Causes
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
Epidemiology and Demographics
It occurs during 3-5% of balloon angioplasty procedures. Its incidence has been markedly reduced with the availability of coronary stents.
Natural History, Complications and 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
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.
References
- PMID 11870931