title: Atrial coronary artery occlusion during elective percutaneous coronary angioplasty.
abstract: BACKGROUND
  Atrial arteries arise from the right and left circumflex coronary arteries and they may be accidentally occluded during percutaneous coronary angioplasty; however, this complication is not well known. The aim of our study was to analyze the incidence and risk factors of accidental atrial branch occlusion (ABO) during elective angioplasty.
  
  
  METHODS
  Clinical records and coronary angiography of 200 patients undergoing elective angioplasty were retrospectively analyzed. Atrial branches were identified and in each vessel we measured the luminal diameter, flow grade, and the location of atherosclerotic plaques. Patients were allocated either into the ABO group if atrial branch flow fell from TIMI grades 2-3 to 0-1 after procedure or in the non-ABO group if TIMI flow was preserved.
  
  
  RESULTS
  Atrial branch occlusion occurred in 43 (21.5%) patients. The atrial branch diameter was larger in non-ABO than in ABO group (1.29mm, SD 0.33 versus 0.97mm, SD 0.22, p=<0.0001). Plaques at atrial branch origin were present in 93% of ABO group, only in 31.8% of non-ABO (p≤0.0001). Predictors of ABO were a cut-off vessel diameter of 1.00mm (ROC 77% sensitivity and 67.5% specificity, p≤0.0001), the presence of atherosclerotic plaque at the ostium of atrial branch and maximal inflation pressure during stenting.
  
  
  CONCLUSIONS
  The occurrence of ABO is frequent after elective angioplasty of right or circumflex coronary arteries in an experienced interventional center. Risk factors were the diameter and the presence of ostial plaques in the atrial branches, and the maximal inflation pressure during stenting.
authors.affiliation: Departament of Cardiology, Hospital de la Santa Creu i Sant Pau, IIb-SantPau, Universitat Autónoma de Barcelona, Barcelona, Spain. Electronic address: jalvarezg@santpau.cat.
authors.forename: Jesús
authors.initials: J
authors.lastname: Álvarez-García
authors.forename: Miquel
authors.initials: M
authors.lastname: Vives-Borrás
authors.forename: Andreu
authors.initials: A
authors.lastname: Ferrero
authors.forename: Dabit Arzamendi
authors.initials: DA
authors.lastname: Aizpurua
authors.forename: Antoni Serra
authors.initials: AS
authors.lastname: Peñaranda
authors.forename: Juan
authors.initials: J
authors.lastname: Cinca
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects* / Q000295:instrumentation; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D003326:Coronary Circulation; D054059:Coronary Occlusion / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000503:physiopathology; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011312:Pressure; D012189:Retrospective Studies; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D015607:Stents
keywords: Atrial coronary artery; Percutaneous transluminal coronary angioplasty; Side-branch occlusion; Stent