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Predictors, therapeutic options and long-term outcome of abrupt reclosure
I N Sinclair1, C H McCabe, M E Sipperly
1Charles A. Dana Research Institute, Boston, Massachusetts.
Insights
Abrupt reclosure after coronary angioplasty occurred in 4.7% of patients. Successful management involved repeat dilatation, medical treatment, or emergency bypass surgery, with factors like thrombus and dissection influencing outcomes.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- Coronary angioplasty is a common procedure for treating coronary artery disease.
- Abrupt reclosure is a significant complication that can occur during or after angioplasty.
- Understanding factors influencing abrupt reclosure is crucial for patient management.
Purpose of the Study:
- To identify clinical and procedural factors associated with the occurrence of abrupt reclosure.
- To analyze different management strategies for abrupt reclosure.
- To evaluate the outcomes of various management approaches for abrupt reclosure.
Main Methods:
- Retrospective analysis of 1,160 consecutive patients undergoing coronary angioplasty.
- Categorization of patients experiencing abrupt reclosure into three management groups: repeat dilatation, medical management, or emergency bypass surgery.
- Comparison of patient characteristics and procedural factors between management groups.
Main Results:
- Abrupt reclosure occurred in 4.7% of patients, with 80% happening during the procedure.
- Patients reopened by dilatation had more thrombus and less dissection than those undergoing emergency surgery.
- Patients managed medically had better collateral flow than surgical patients.
- Emergency surgery had a 1.6% rate, with 56% experiencing myocardial infarction.
Conclusions:
- Clinical and procedural factors, including luminal thrombus and local dissection, influence the management of abrupt reclosure.
- Repeat dilatation is favored in cases with thrombus and minimal dissection.
- Medical management is suitable for patients with adequate collateral flow.
- Emergency bypass surgery is associated with higher rates of myocardial infarction but good long-term outcomes.
Abstract:
To ascertain the clinical and procedural factors that relate to the occurrence and management of abrupt reclosure, data on 1,160 consecutive patients who underwent coronary angioplasty between December 1981 and December 1986 were analyzed. Abrupt reclosure occurred in 54 patients (4.7%), developing during the dilatation procedure in 43 patients (80%) and delayed by 11 +/- 2 hours after the procedure in 11 patients (20%). Patients were divided into 3 groups based on subsequent management: (1) 22 patients (40%) in whom the involved vessel was reopened by additional dilatation, (2) 14 patients (26%) in whom the involved vessel was not reopened but the patient was treated medically, and (3) 18 patients (33%) in whom abrupt reclosure was managed by emergency bypass surgery, yielding an overall emergency surgery rate of 1.6%. Patients whose abrupt reclosure was reopened were more likely to have luminal thrombus (54 vs 28%) and less likely to have extensive local dissection after dilatation (14 vs 61%; p less than 0.025) than patients undergoing emergency surgery. Patients treated medically despite continued vessel occlusion were more likely to have collateral blood flow to the occluded zone (54 vs 11%, p less than 0.01) than patients undergoing surgery. While 10 of 18 patients (56%) undergoing emergency surgery sustained a myocardial infarction, all patient subgroups appeared to do well during long-term follow-up.