Abrupt closure during coronary intervention: Difference between revisions
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Abrupt closure is defined as the development of TIMI grade 0 or 1 flow during percutaneous coronary intervention (PCI). If a patient begins the procedure with TIMI grade 0 or 1 flow, the term abrupt closure is applied if during some point in the procedure there was restoration of TIMI grade 3, which was followed by a recurrence of TIMI grade 0 or 1 flow. | Abrupt closure is defined as the development of TIMI grade 0 or 1 flow during percutaneous coronary intervention (PCI). If a patient begins the procedure with TIMI grade 0 or 1 flow, the term abrupt closure is applied if during some point in the procedure there was restoration of TIMI grade 3, which was followed by a recurrence of TIMI grade 0 or 1 flow. | ||
==Causes== | |||
Abrupt closure may be due to [[coronary dissection]], [[embolization]], or [[thrombus]] formation within the [[vessel]]. | |||
==Epidemiology and Demographics== | |||
It occurs during 3-5% of balloon angioplasty procedures. Its [[incidence]] has been markedly reduced with the availability of [[coronary stent]]s. | |||
==Risk Factors<ref name="pmid11870931">{{cite journal| author=Suh WW, Grill DE, Rihal CS, Bell MR, Holmes DR, Garratt KN| title=Unrestricted availability of intracoronary stents is associated with decreased abrupt vascular closure rates and improved early clinical outcomes. | journal=Catheter Cardiovasc Interv | year= 2002 | volume= 55 | issue= 3 | pages= 294-302 | pmid=11870931 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11870931 }} </ref>== | |||
*Clinical: [[unstable angina]], female, [[AMI]], [[chronic renal failure]] | |||
*[[Angiographic]]: [[Intraluminal]] [[thrombus]], ACC/AHA score, [[multivessel coronary artery disease|multivessel disease]], long [[lesion]]s, >45 degree angulation, branch points, [[proximal]] [[tortuosity]], ostial [[RCA]], degenerated [[SVG]]s, pre[[stenosis]] >90%, [[intimal]] [[dissection]]s | |||
==Natural History, Complications and Prognosis== | |||
Factors predicting mortality after abrupt closure are as follows: | |||
*% [[myocardium]] at risk | |||
*LM and [[multivessel coronary artery disease|multivessel disease]] | |||
*[[CHF]], [[UAP]] | |||
*Target [[vessel]]s supplies [[collateral]]s | |||
*> 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|stent thrombosis]] | |||
*Rx: maintain flow, complete coverage. | |||
==Abrupt Closure Examples== | |||
===[[Abrupt closure case 1|Case 1]]=== | |||
===[[Abrupt closure case 2|Case 2]]=== | |||
===[[Abrupt closure case 3|Case 3]]=== | |||
===[[Abrupt closure case 4|Case 4]]=== | |||
===[[Abrupt closure case 5|Case 5]]=== | |||
===[[Abrupt closure case 6|Case 6]]=== | |||
===[[Abrupt closure case 7|Case 7]]=== | |||
===[[Abrupt closure case 8|Case 8]]=== | |||
===[[Abrupt closure case 9|Case 9]]=== | |||
===[[Abrupt closure case 10|Case 10]]=== | |||
===[[Abrupt closure case 11|Case 11]]=== | |||
===[[Abrupt closure case 12|Case 12]]=== | |||
===[[Abrupt closure case 13|Case 13]]=== | |||
===[[Abrupt closure case 14|Case 14]]=== | |||
===[[Abrupt closure case 15|Case 15]]=== | |||
===[[Abrupt closure case 16|Case 16]]=== | |||
===[[Abrupt closure case 17|Case 17]]=== | |||
===[[Abrupt closure case 18|Case 18]]=== | |||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
[[Category:Cardiology]] | [[Category:Cardiology]] | ||
[[Category:Angiopedia]] | |||
{{WH}} | {{WH}} | ||
{{WS}} | {{WS}} | ||
Revision as of 17:36, 22 August 2013
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Abrupt closure is defined as the development of TIMI grade 0 or 1 flow during percutaneous coronary intervention (PCI). If a patient begins the procedure with TIMI grade 0 or 1 flow, the term abrupt closure is applied if during some point in the procedure there was restoration of TIMI grade 3, which was followed by a recurrence of TIMI grade 0 or 1 flow.
Causes
Abrupt closure may be due to coronary dissection, embolization, or thrombus formation within the vessel.
Epidemiology and Demographics
It occurs during 3-5% of balloon angioplasty procedures. Its incidence has been markedly reduced with the availability of coronary stents.
Risk Factors[1]
- 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
Natural History, Complications and Prognosis
Factors predicting mortality after abrupt closure are as follows:
- % 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.
Abrupt Closure Examples
Case 1
Case 2
Case 3
Case 4
Case 5
Case 6
Case 7
Case 8
Case 9
Case 10
Case 11
Case 12
Case 13
Case 14
Case 15
Case 16
Case 17
Case 18
References
- ↑ Suh WW, Grill DE, Rihal CS, Bell MR, Holmes DR, Garratt KN (2002). "Unrestricted availability of intracoronary stents is associated with decreased abrupt vascular closure rates and improved early clinical outcomes". Catheter Cardiovasc Interv. 55 (3): 294–302. PMID 11870931.