Extension of a Coronary Intramural Hematoma as a Complication of Early Percutaneous Coronary Intervention after Thrombolytic Therapy

Abstract

The optimal treatment approach for coronary intramural hematomas has not been well defined, and discussion is limited to scarce data. In addition, the impact of prior thrombolytic therapy in the setting of coronary artery dissections with possible development and/or extension of an intramural hematoma is not well understood. We describe a case of iatrogenic periprocedural dissection of the left anterior descending artery (LAD) with development of an intramural hematoma and the extension of this hematoma to the left main (LM) and left circumflex (LCX) arteries in a middle-aged female, where prior recent thrombolytic therapy may have played a role in its triggering or facilitation of its extension. This case highlights the importance of facilitation of bleeding complications by prior use of thrombolytic therapy not only peripherally but intracoronary too and the use of intravascular ultrasound for both diagnosis, followup, and percutaneous coronary intervention (PCI) guidance.

Extension of a coronary intramural hematoma after blunt chest trauma

“…[14] A previous study reported that previous thrombolytic therapy affected hematoma extension after PCI. [12] In the present case, it was thought that microvascular damage of the blood vessels might have affected the hematoma.…”

“…The hematoma was successfully detected by IVUS and treated with multiple stents. A few cases of coronary artery dissection and extension of an intramural hematoma after PCI have been reported; [12,13] however, to our knowledge, this is the first case of extension of an intramural hematoma after blunt chest trauma.…”

Coronary intramural hematoma: Challenges in diagnosis and management

“…Due to the rarity of this clinical scenario, no randomized controlled trials exist to guide treatment, and no consensus regarding management is available. [6] Currently, treatment strategies are based on a case by case clinical assessment and experiences. [1] Treatment options for intramural hematomas include conservative medical therapy, close angiographic follow-up, and PCI.…”

Stent Implantation May Fail Sometimes in Coronary Complications: Extension of an Iatrogenic Left Main Coronary Artery Hematoma

“…The incidence of intramural hematomas, according to intravascular ultrasonography (IVUS), is up to 6.7%. 1 , 2 Such complications can be treated with either interventional stenting or surgery or could be followed up conservatively. This report presents a rare case of coronary dissection and intramural hematoma undergoing coronary artery bypass grafting due to the propagation of the hematoma toward the left anterior descending artery (LAD).…”