Abrupt closure during coronary intervention

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1], Alexandra Almonacid M.D. [2], Jeffrey J. Popma M.D. [3]; Associate Editor(s)-in-Chief: Hardik Patel, M.D., Sapan Patel M.B.B.S

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.

Epidemiology and Demographics

It occurs during 3-5% of balloon angioplasty procedures. Its incidence has been markedly reduced with the availability of coronary stents.

Risk Factors

• 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

Natural History, Complications and Prognosis

Factors predicting mortality after abrupt closure are as follows:

• % 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.