PCI Complications: Abrupt Closure

Editors-In-Chief: Alexandra Almonacid M.D. [mailto:aalmonacid@partners.org] and Jeffrey J. popma M.D. [mailto:jpopma@partners.org]

Definition
Abrupt closure during coronary intervention is defined as an abrupt cessation of coronary flow to TIMI 0 or 1.

Incidence
Occurs during 3-5% of balloon angioplasty procedures. Its incidence has been markedly reduced with the availability of coronary stents (1).

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

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

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


 * 1) ref1 PMID 11870931