Korean Circ J.  2009 Apr;39(4):171-174. 10.4070/kcj.2009.39.4.171.

Intravascular Ultrasound-Guided Troubleshooting in a Large Hematoma Treated With Fenestration Using a Cutting Balloon

• Noh HJ
• Choi JH
• Song YB
• Jo HC
• Yang JH
• Kim SM
• Lee HJ
• Choi JH
• Choi SH
• Hahn JY
• Choi SH
• Gwon HC

• KMID: 2225694
• DOI: http://doi.org/10.4070/kcj.2009.39.4.171

Abstract

Intramural hematoma formation is not a well-studied complication of percutaneous coronary intervention. We describe a patient with stable angina who developed an intramural hematoma during elective percutaneous coronary intervention (PCI) in the right coronary artery (RCA). Total occlusion with dense dye staining developed a long way from the distal RCA, near the posterior descending artery bifurcation site. The true lumen was compressed by the enlarged, tense, false lumen. The patient was successfully treating with intravascular ultrasound-guided fenestration using a cutting balloon, and a stent was implanted in the distal RCA.

Keyword

Hematoma; Angioplasty; Intravascular ultrasonography

MeSH Terms

Angina, Stable
Angioplasty
Arteries
Coronary Vessels
Hematoma
Humans
Percutaneous Coronary Intervention
Stents
Transcutaneous Electric Nerve Stimulation
Ultrasonography, Interventional

Figure

• 

  Fig. 1 Elective coronary angiography. The arrow indicates focal stenosis leading to 90% luminal narrowing in the mid-right coronary artery. The arrowhead indicates 99% luminal narrowing of the posterior descending artery ostium.

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  Fig. 2 Angiographic view of new narrowing that formed after stenting. Arrows indicate total occlusion and dye staining far from the distal right coronary artery, near the posterior descending artery bifurcation site.

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  Fig. 3 Site of the intramural hematoma that formed after stenting. Intravascular ultrasound revealed total compression of the distal right coronary artery lumen, which was caused by a huge hematoma (arrowheads).

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  Fig. 4 Coronary angiogram after cutting balloon fenestration between the true lumen and the hematoma.

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