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

Abstract

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.

Prevalence, Features, and Prognostic Importance of Edge Dissection After Drug-Eluting Stent Implantation

“…Maehara et al 30 and Liu et al 22 showed that the prevalence of intramural hematoma after PCI was 6.7% (69 of 1025 lesions) and 2.7% (28 of 1045 lesions), respectively; Maehara et al 8 reported in another IVUS study that the prevalence of extramedial damage after PCI was 0.5% (76 of 15 000 lesions), higher compared with our present results. However, and unlike the current report, these studies included patients with periprocedural events.…”

Optical Coherence Tomography Findings in an Acquired Coronary Fistula

“…1 This phenomenon has been found after percutaneous coronary intervention and has been suggested as a cause of acute coronary syndromes and spontaneous coronary artery dissections. 1 In the latter, it has been proposed that a primary disruption of the vasa vasorum within the media can lead to an intramedial hemorrhage, which ultimately produces an intimal tear.…”

“…1 This phenomenon has been found after percutaneous coronary intervention and has been suggested as a cause of acute coronary syndromes and spontaneous coronary artery dissections. 1 In the latter, it has been proposed that a primary disruption of the vasa vasorum within the media can lead to an intramedial hemorrhage, which ultimately produces an intimal tear. Importantly, in the absence of atherosclerosis (as in our case), it has also been suggested that the dissection plane more probably lies in the outer third of the media or at its junction with the adventitia, leading to a subadventitial noncommunicating hematoma.…”

Migrating type a intramural hematoma after repair of an anomalous right coronary artery aortocoronary dissection with a covered stent

“…IMH is a variant of aortic dissection, defined as absence of an intimal tear without direct communication between the false and true lumen. The exact mechanism of IMH is not clear, but the risk factors including advanced age, uncontrolled hypertension, and aortic root calcification [8].…”