Abrupt vessel closure after directional coronary atherectomy

Jeffrey J. Popma, Eric J. Topol, Tomoaki Hinohara, Cass A. Pinkerton, Donald S. Baim, Spencer B. King, David Holmes, Patrick L. Whitlow, Dean J. Kereiakes, Geoffrey O. Hartzler, Kenneth M. Kent, Stephen G. Ellis, John B. Simpson

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44 Scopus citations

Abstract

From October 1, 1986 to December 31, 1989 directional coronary atherectomy was performed during 1,020 procedures (1,140 lesions) at 14 clinical centers. Abrupt vessel closure, defined as a total coronary occlusion or subtotal occlusion associated with clinical evidence of myocardial ischemia, occurred in 43 procedures (4.2%). It developed in the catheterization laboratory in 34 patients, but was delayed 1 to 96 h after directional atherectomy in 9 patients. By univariate analysis the incidence of abrupt closure was higher in directional atherectomy of de novo lesions (p < 0.001), lesions in the right coronary artery (p = 0.001) and diffuse lesions (p = 0.04). The incidence of abrupt closure tended to be lower in directional atherectomy of saphenous vein grafts as opposed to native coronary arteries (1.6% vs. 4.4%; p = 0.08). Clinical findings during abrupt closure included severe angina in 26 patients, myocardial infarction in 17 patients, hypotension in 5 patients and death in 2 patients. Balloon angioplasty was attempted in 32 patients after abrupt vessel closure. In 16 patients balloon angioplasty resulted in initial resolution of the closure episode, although 1 patient died 96 h after the procedure. Fifteen of 16 patients without initial improvement alter balloon angioplasty underwent coronary bypass operation; 9 additional patients with abrupt closure were referred directly for bypass operation. It is concluded that abrupt vessel closure develops relatively infrequently after directional coronary atherectomy. In the absence of severe coronary dissection, abrupt closure after directional atherectomy may be effectively managed with balloon angioplasty in some cases, although coronary bypass operation is often required.

Original languageEnglish (US)
Pages (from-to)1372-1379
Number of pages8
JournalJournal of the American College of Cardiology
Volume19
Issue number7
DOIs
StatePublished - Jan 1 1992
Externally publishedYes

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Popma, J. J., Topol, E. J., Hinohara, T., Pinkerton, C. A., Baim, D. S., King, S. B., Holmes, D., Whitlow, P. L., Kereiakes, D. J., Hartzler, G. O., Kent, K. M., Ellis, S. G., & Simpson, J. B. (1992). Abrupt vessel closure after directional coronary atherectomy. Journal of the American College of Cardiology, 19(7), 1372-1379. https://doi.org/10.1016/0735-1097(92)90590-J