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| __NOTOC__
| | #redirect[[Abrupt closure]] |
| {{PCI}}
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| '''Editors-In-Chief''': Alexandra Almonacid M.D. [mailto:aalmonacid@partners.org]; Jeffrey J. Popma M.D. [mailto:jpopma@partners.org]
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| ==Overview==
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| Abrupt closure during [[interventional cardiology|coronary intervention]] is defined as an abrupt cessation of [[coronary blood flow|coronary flow]] to [[TIMI flow grade 0|TIMI 0]] or [[TIMI flow grade 1|1]].
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| ==Causes==
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| Abrupt closure may be due to [[coronary dissection]], [[embolization]], or [[thrombus]] formation within the [[vessel]].
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| ==Epidemiology and Demographics==
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| It occurs during 3-5% of balloon angioplasty procedures. Its [[incidence]] has been markedly reduced with the availability of [[coronary stent]]s.
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| ==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>==
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| *Clinical: [[unstable angina]], female, [[AMI]], [[chronic renal failure]]
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| *[[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
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| ==Natural History, Complications and Prognosis==
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| Factors predicting mortality after abrupt closure are as follows:
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| *% [[myocardium]] at risk
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| *LM and [[multivessel coronary artery disease|multivessel disease]]
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| *[[CHF]], [[UAP]]
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| *Target [[vessel]]s supplies [[collateral]]s
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| *> age 65 years
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| *[[Chronic renal failure]]
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| *Female gender
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| *[[Diabetes]]
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| ==Treatment==
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| ===Stent Use in Abrupt Closure===
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| *Gianturco-Roubin [[stent]] improves [[lumen]] size and reduced MACE
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| *PS [[stent]] improves outcome: [[mortality]] 1.3%, [[MI]] 4%, 1% [[CABG]]
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| *[[ACS]] Multi-Link: [[mortality]] 1.4%, MI 2.9%
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| *Mostly associated with [[subacute]] [[Stent Thrombosis|stent thrombosis]]
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| *Rx: maintain flow, complete coverage.
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| ==Abrupt Closure Examples==
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| ===[[ANGLIB 003-001|Case 1]]===
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| ===[[ANGLIB 003-002|Case 2]]===
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| ===[[ANGLIB 003-003|Case 3]]===
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| ===[[ANGLIB 003-004|Case 4]]===
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| ===[[ANGLIB 003-005|Case 5]]===
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| ===[[Abrupt closure case 6|Case 6]]===
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| ===[[Abrupt closure case 7|Case 7]]===
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| ===[[Abrupt closure case 8|Case 8]]===
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| ==References==
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| {{reflist|2}}
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| [[Category:Up-To-Date]]
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| [[Category:Up-To-Date cardiology]]
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| [[Category:Cardiology]]
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