Management of Abrupt Vessel Closure During Percutaneous Coronary Intervention: A Narrative Review

Abrupt vessel closure (AVC) is a complication of percutaneous coronary intervention (PCI) and is defined as the sudden cessation of forward coronary blood flow due to a variety of mechanisms.The incidence of AVC has markedly decreased from approximately 3.0% in the early era to about 0.3% today.Nevertheless, cardiovascular interventionists must remain prepared to manage AVC effectively, given its significant impact on clinical outcomes.AVC can arise from several mechanisms, including dissection, intramural hematoma, intracoronary thrombosis, air embolism, vasospasm, and no-reflow.The clinical impact of AVC varies depending on the extent of myocardium affected, ranging from asymptomatic events or transient ischemic chest pain to cardiogenic shock or cardiac arrest.Both a general approach for stabilizing hemodynamic consequences and an etiology-specific management strategy are essential.Hasty decision-making may worsen the situation, whereas a structured approach-focused on hemodynamic stabilization, logical diagnostic processes, and targeted interventions-can improve outcomes.In this narrative review, we describe the mechanisms underlying each etiology, outline mechanism-specific management strategies, and discuss general approaches to managing patients with AVC through logical diagnostic and treatment processes.We hope this review offers valuable insights into this uncommon but significant complication and enhances readers' skills in managing AVC more effectively during PCI.