Extramural vessel wall hematoma causing a reduced vessel diameter after coronary stenting: Diagnosis by intravascular ultrasound and treatment by stent implantation

Mahr, P.; Ge, Junbo; Haude, Michael; Görge, G; Erbel, Raimund

doi:10.1002/(sici)1097-0304(199804)43:4<438::aid-ccd18>3.0.co;2-f

Cited by 10 publications

(7 citation statements)

References 13 publications

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“…IVUS is useful to identify intramural hematoma [5,9,10]. In our case, IVUS imaging also revealed the dissection into the media with extension into the medial space without reentry, and demonstrated a significant stenosis and obstruction of the distal LAD with a semilunar echo-dense intramural hematoma.…”

Section: Discussionsupporting

confidence: 52%

Balloon rupture during coronary angioplasty causing dissection and intramural hematoma of the coronary artery; a case report

Katayama¹,

Sakoda²,

Yamamoto³

et al. 2010

Journal of Cardiology Cases

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A 73-year-old male with diabetes mellitus was referred for coronary angiography (CAG). He presented with stable effort angina pectoris. CAG showed a significant stenotic lesion in the proximal-segment of the left anterior descending (LAD) coronary artery with heavy calcification. He then underwent angioplasty for the LAD stenosis. On the second balloon dilatation, the balloon was inflated to 22 atm, at which point the balloon waist had not yet yielded and balloon rupture occurred. Immediately after the procedure, CAG showed no-reflow phenomena and chest pain occurred. Intravascular ultrasound (IVUS) imaging revealed a dissection into the media with extension into the medial space without reentry, and demonstrated significant stenosis and obstruction of the distal LAD with a semilunar echo-dense intramural hematoma. To bail out, two bare metal stents were deployed. After the procedure, proper stents expansion and no residual dissection flap were detected either by IVUS or CAG. The final CAG showed a good result with TIMI-3 coronary flow. This case highlights balloon rupture during coronary angioplasty with heavy calcification caused no-reflow phenomena by dissection and intramural hematoma of the coronary artery. We could bail out hematoma by coronary stent implantation with complete cover of the coronary dissection.

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Section: Discussionsupporting

confidence: 52%

Balloon rupture during coronary angioplasty causing dissection and intramural hematoma of the coronary artery; a case report

Katayama¹,

Sakoda²,

Yamamoto³

et al. 2010

Journal of Cardiology Cases

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“…9,11,17 The echogenicity of blood depends on the flow rate, red cell aggregation, and fibrin content. 18 -20 Yamada et al 18 reported that the backscatter intensity of blood increased dramatically with stagnant flow.…”

Section: Ivus Appearancementioning

confidence: 99%

Incidence, Morphology, Angiographic Findings, and Outcomes of Intramural Hematomas After Percutaneous Coronary Interventions

et al. 2002

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Background-Intramural hematomas during percutaneous coronary intervention (PCI) have not been well studied. Methods and Results-We used intravascular ultrasound to determine the incidence, morphology, and clinical features of post-PCI intramural hematomas. In 905 patients with 1025 consecutive native coronary artery, non-in-stent restenosis lesions undergoing PCI, 72 hematomas were detected in 69 arteries in 68 patients. The incidence of intramural hematomas per artery was 6.7% (69 of 1025); 36% (26 of 72) involved the proximal reference artery, 18% (13 of 72) were confined to the lesion, and 46% (33 of 72) involved the distal reference artery. The entry site from the lumen into the hematoma was identified in 86% of hematomas (62 of 72) and had the appearance of a dissection into the media. Conversely, a re-entry site was identifiable in only 8% (6 of 72). The axial extension of the hematoma was distal in 63% and proximal in 37%. In 60% of the hematomas (42 of 72) the angiogram had the appearance of a dissection; in 11% (8 of 72), it appeared to be a new stenosis; and in 29% (22 of 72), no significant abnormality was detected. Non-Q-wave myocardial infarctions occurred in 26% of patients (17 of 65). In 3 patients, the creatine kinase-MB was not measured during the hospital stay. Repeat revascularization occurred in 2 patients in-hospital, 2 additional patients at 1 month, and 8 additional patients at 1 year. There were 3 sudden deaths at 1 year. Conclusions-Intravascular ultrasound identified intramural hematomas after 6.7% of PCIs. The mechanism appeared to be a dissection into the media where blood accumulated because of a lack of re-entry. A third of ultrasound-identified hematomas showed no angiographic abnormalities. There was a high rate of non-Q-wave myocardial infarction, need for repeat revascularization, and sudden death in patients with hematomas.

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“…Several cases of intra- or extra-mural hematomas after PCI have been reported, which were successfully treated with coronary stenting 2)11-13). In our case, the blood entry site appeared as a dissection within the media and adventitia and resulted in combined intra- and extra-mural hematomas as detected by IVUS, although there was no evidence of extravasation of contrast media into the pericardium by coronary angiogram.…”

Section: Discussionmentioning

confidence: 53%

“…Compared with an intramural hematoma, the incidence and mechanism of extramural hematomas are not well established. Mahr et al2) reported a case of an extramural hematoma causing a reduced distal vessel diameter after coronary stenting, which was treated with another coronary stent. Similar to the mechanism of an intramural hematoma, dissection into the adventitia plays a beginning point of blood entry, which can be detected by IVUS.…”

Section: Discussionmentioning

confidence: 99%

A Case of Intra- and Extra-Mural Hematomas During Recanalization for Chronic Total Occlusion

et al. 2010

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An intramural hematoma is an accumulation of blood between the internal and external elastic membranes within the medial space, whereas an extramural hematoma is a dilution and/or dissemination of blood throughout the adventitia. Intra- and extra-hematomas are observed by intravascular ultrasound during percutaneous coronary intervention (PCI). The patient described herein presented with angina pectoris. Her coronary angiogram showed diffuse narrowing of the mid-left anterior descending artery and total occlusion of the distal right coronary artery (RCA). Intra- and extra-mural hematomas developed during PCI of the RCA; however, the lesions were covered successfully using long drug-eluting stents.

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Extramural vessel wall hematoma causing a reduced vessel diameter after coronary stenting: Diagnosis by intravascular ultrasound and treatment by stent implantation

Cited by 10 publications

References 13 publications

Balloon rupture during coronary angioplasty causing dissection and intramural hematoma of the coronary artery; a case report

Balloon rupture during coronary angioplasty causing dissection and intramural hematoma of the coronary artery; a case report

Incidence, Morphology, Angiographic Findings, and Outcomes of Intramural Hematomas After Percutaneous Coronary Interventions

A Case of Intra- and Extra-Mural Hematomas During Recanalization for Chronic Total Occlusion

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