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Case Reports
. 2019 Jan-Mar;20(1):17-20.
doi: 10.4103/HEARTVIEWS.HEARTVIEWS_15_19.

Coronary Intramural Hematoma: Challenges in Diagnosis and Management

Muhammed Moidy  1 , Fahad Al Kindi  1
Affiliations
Case Reports

Coronary Intramural Hematoma: Challenges in Diagnosis and Management

Muhammed Moidy et al. Heart Views. 2019 Jan-Mar.

Abstract

Coronary intramural hematoma (CIH) after percutaneous coronary intervention (PCI) is a rare cause of acute coronary syndrome. As the diagnosis is really challenging, its incidence is really under estimated. The optimal management of post-PCI CIH has not been well defined. Conventional coronary angiography alone is often insufficient to identify a CIH. Intravascular ultrasound and optical coherence tomography (OCT) are helpful modalities for diagnosis and evaluation of its extension. We present a case of CIH after PCI, highlighting our experience in the diagnostic accuracy of OCT and our strategy in the management of this case.

Keywords: Coronary intramural hematoma; diagnosis; intravascular ultrasound; management; optical coherence tomography.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Angiography of the left coronary artery demonstrating the original stenosis in the mid-left circumflex artery (arrow)
Figure 2
Figure 2
Angiography of the left coronary artery demonstrating successful stent implantation in the mid-left circumflex artery (arrow)
Figure 3
Figure 3
Relook angiography of the left coronary artery showing a new long and hazy luminal narrowing just distal to the stent (arrow)
Figure 4
Figure 4
(a) Optical coherence tomography of the left circumflex artery showing edge dissection distal to the stent. (b) Optical coherence tomography of the left circumflex artery showing intramural hematoma secondary to edge dissection distal to the stent
Figure 5
Figure 5
Relook angiography of the left coronary artery showed successful stent implantation in the proximal obtuse marginal artery (arrow)
Figure 6
Figure 6
Poststenting optical coherence tomography of the left circumflex artery showing complete resolution of intramural hematoma and edge dissection, with well-apposed stent
See this image and copyright information in PMC

References

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