Acute Vessel Closure After Balloon Angioplasty

Acute vessel closure after balloon angioplasty

Common causes of acute vessel closure after balloon angioplasty are:

1. Dissection of the vessel intima during balloon inflation
2. Recoil of the vessel after balloon angioplasty
3. Thrombosis in the vessel lumen
4. Spasm of the vessel

Stenting the vessel after angioplasty can reduce the chance of acute vessel closure markedly. That is why POBA or plain old balloon angioplasty is seldom a definitive procedure now a days. Balloon angioplasty is invariably followed by stent implantation unless the vessel is too small to be stented or there is poor distal run off, which is likely to cause acute stent thrombosis.

In an earlier study, of 1319 consecutive patients who underwent coronary angioplasty procedures between 1st July 1988 and 30th June 1990, 109 patients (8.3%) had abrupt vessel closure [1]. The closure occurred at a median time of 27 minutes (range 0 minutes to 5 days) from the first balloon inflation. Angiographically, thrombus was detected in 20% and coronary dissection noted in 28% cases. Both thrombus and dissection were noted in 7% cases. In 45% of cases it was due to indeterminate mechanisms.

Reference

1. A M Lincoff, J J Popma, S G Ellis, J A Hacker, E J Topol. Abrupt Vessel Closure Complicating Coronary Angioplasty: Clinical, Angiographic and Therapeutic Profile. J Am Coll Cardiol. 1992 Apr;19(5):926-35.