ABRUPT VESSEL CLOSURE - CHANGING IMPORTANCE, MANAGEMENT, AND CONSEQUENCES

Percutaneous coronary interventions have been performed for 20 years. Despite the success and progress of these interventions, abrupt vessel closure has been a dramatic adverse event of coronary interventions. Closure has frequently led to the major complications of death, myocar dial infarction, and emergency coronary artery bypass. Because of the fear of this adverse event and its subsequent complications, the appli cability of coronary interventions is sometimes limited. The pathologi c characteristics of abrupt vessel closure have been recognized as pre dominantly caused by dissection, with vessel recoil and thrombus forma tion playing important secondary roles. The recognition of the lesions at risk for abrupt vessel closure has led to a strategy of lesion-spe cific device therapy to reduce complications. Similarly the role of an tiplatelet and antithrombotic therapies have reduced complications. Th e earliest methods of dealing with abrupt closure was emergency corona ry artery bypass surgery with significant rates of morbidity and morta lity. With the advent of second-generation devices and techniques, par ticularly stents, the management of abrupt vessel closure has been sim plified and alternatives to emergency coronary bypass are more availab le. This article will review the history and current status of the pre vention and management of abrupt vessel closure and demonstrate that a nticipation and management of this complication have been facilitated with reduction of subsequent complications and increased applicability of coronary interventions.