View source for Abrupt closure during coronary intervention

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{{PCI}}
Editor(s)-In-Chief: [[User:C Michael Gibson|C. Michael Gibson, M.S., M.D.]][mailto:charlesmichaelgibson@gmail.com], Alexandra Almonacid M.D. [mailto:aalmonacid@partners.org], Jeffrey J. Popma M.D. [mailto:jpopma@partners.org]; {{AE}} {{HP}}, {{Sapan}}

==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]].
==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]]===

===[[Abrupt closure case 19|Case 19]]===

===[[Abrupt closure case 20|Case 20]]===

==References==
{{reflist|2}}
[[Category:Cardiology]]
[[Category:Angiopedia]]
[[Category:Up-To-Date]]
[[Category:Up-To-Date cardiology]]
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