Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 May 20;2(5):707-708.
doi: 10.1016/j.jaccas.2020.03.011. eCollection 2020 May.

Coronary Artery Occlusion Caused by Intramural Hematoma Due to In-Stent Dissection

Yasushi Ueki  1 , Lorenz Räber  1 , Raminta Kavaliauskaite  1 , Tatsuhiko Otsuka  1 , George C M Siontis  1
Affiliations

Coronary Artery Occlusion Caused by Intramural Hematoma Due to In-Stent Dissection

Yasushi Ueki et al. JACC Case Rep. .

Abstract

A 54-year-old man developed ST-segment elevation myocardial infarction 1 week after percutaneous coronary intervention of the left anterior descending artery. Optical coherence tomography at the emergent percutaneous coronary intervention revealed an intramural hematoma extending from the in-stent dissection. We highlight that in-stent dissection, although generally considered a benign finding, can extend and cause intramural hematoma, resulting in coronary artery occlusion. (Level of Difficulty: Intermediate.).

Keywords: LAD, left anterior descending artery; OCT, optical coherence tomography; PCI, percutaneous coronary intervention; acute myocardial infarction; dissection; intramural hematoma; optical coherence tomography; percutaneous coronary intervention.

PubMed Disclaimer

Figures

None
Graphical abstract
Figure 1
Figure 1
Coronary Angiography and OCT Findings (A) Angiography after stent implantation (3.5 × 33 mm) to the proximal left anterior descending artery. Optical coherence tomography (OCT) showed the minor in-stent dissection (B, white arrow) but neither dissection/hematoma at the diagonal ostium (C) nor distal stent edge (D and E). (F) Angiography 1 week after the index percutaneous coronary intervention showed subtotal occlusion distal to the implanted stent. (G) In-stent dissection (white arrow) was more pronounced compared with that observed at the index percutaneous coronary intervention (B). (H and I) Hematoma (asterisk) was confirmed around in-stent dissection. (J) Circumferential hematoma (asterisk) causing significant luminal stenosis.
Supplemental Figure 1
Supplemental Figure 1
See this image and copyright information in PMC

References

    1. Soeda T., Uemura S., Park S.J. Incidence and clinical significance of poststent optical coherence tomography findings: one-year follow-up study from a multicenter registry. Circulation. 2015;132:1020–1029. - PubMed
    1. De Cock D., Bennett J., Ughi G.J. Healing course of acute vessel wall injury after drug-eluting stent implantation assessed by optical coherence tomography. Eur Heart J Cardiovasc Imaging. 2014;15:800–809. - PubMed
    1. Asakura K., Minami Y., Sato D., Shiono T., Ako J. Intramural hematoma due to in-stent dissection causing acute coronary occlusion. J Am Coll Cardiol Intv. 2018;11 e131–3. - PubMed