PCI complications: abrupt closure: Difference between revisions
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==Overview== | ==Overview== | ||
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 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]]. | ||
==Causes== | ==Causes== | ||
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]]. | ||
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*Clinical: [[unstable angina]], female, [[AMI]], [[chronic renal failure]] | *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 | *[[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 | ||
===Prognosis=== | ==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. | |||
==Natural History, Complications and Prognosis=== | |||
===Factors Predicting Mortality after Abrupt Closure=== | |||
*% [[myocardium]] at risk | *% [[myocardium]] at risk | ||
*LM and [[multivessel coronary artery disease|multivessel disease]] | *LM and [[multivessel coronary artery disease|multivessel disease]] |
Revision as of 14:03, 17 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.
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