PCI complications: abrupt closure: Difference between revisions
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'''Editors-In-Chief''': Alexandra Almonacid M.D. [mailto:aalmonacid@partners.org], Jeffrey J. | '''Editors-In-Chief''': Alexandra Almonacid M.D. [mailto:aalmonacid@partners.org], Jeffrey J. Popma M.D. [mailto:jpopma@partners.org] | ||
==Overview== | ==Overview== | ||
Abrupt closure during coronary intervention is defined as an abrupt cessation of coronary flow to TIMI 0 or 1. | 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]]. | ||
==Abrupt Closure== | ==Abrupt Closure== | ||
===Incidence=== | ===Incidence=== | ||
It occurs during 3-5% of balloon angioplasty procedures. Its [[incidence]] has been markedly reduced with the availability of [[coronary stent]]s. | |||
===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 | *[[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 | ||
===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]] | ||
*ACS Multi-Link: mortality 1.4%, MI 2.9% | *[[ACS]] Multi-Link: [[mortality]] 1.4%, MI 2.9% | ||
*Mostly associated with subacute stent thrombosis | *Mostly associated with [[subacute]] [[Stent Thrombosis|stent thrombosis]] | ||
*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 coronary artery disease|multivessel disease]] | ||
*CHF, UAP | *[[CHF]], [[UAP]] | ||
*Target | *Target [[vessel]]s supplies [[collateral]]s | ||
*> age 65 years | *> age 65 years | ||
*Chronic renal failure | *[[Chronic renal failure]] | ||
*Female gender | *Female gender | ||
*Diabetes | *[[Diabetes]] | ||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} |
Revision as of 18:52, 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
It occurs during 3-5% of balloon angioplasty procedures. Its incidence has been markedly reduced with the availability of coronary stents.
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
- PMID 11870931