Chapter 25 - Acute vessel closure

Abstract

Acute vessel closure is defined as (partial or complete) decrease in antegrade coronary flow that occurs during or immediately after percutaneous coronary intervention. The key steps for approaching such lesions are to maintain guidewire position and to determine the cause of acute vessel closure and treat accordingly. Acute vessel closure due to dissection or aorto-coronary dissection is usually treated with stenting (after maintaining or obtaining distal true lumen guidewire position). Thrombosis and embolization are usually treated with thrombectomy and optimization of anticoagulation and antiplatelet therapy. Air embolization is usually self-limiting and is treated with 100% oxygen administration and supportive measures. Side branch occlusion after bifurcation stenting is best prevented by wiring the side branch or using an upfront two-stent strategy if the risk of side branch loss is high. Spasm is treated with vasodilator administration. Pseudolesions are treated by removal of the causal intracoronary equipment. Intramural hematomas are usually treated with distal stenting to prevent distal propagation.