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Volume 5

Journal of Current Research: Cardiology

Heart Congress 2018

November 21-22, 2018

Page 16



Global Heart Congress

November 21-22, 2018 Osaka, Japan

Post PCI coronary intramural hematoma causing NSTEMI and short runs of VT


he optimal management of coronary intramural hematoma has not been well defined. Their occurrence can be a diagnostic

challenge to the interventionist. Ischemia and hemodynamic compromise are possible complications, if not managed

promptly. Conventional coronary angiography alone is often insufficient to identify an intramural hematoma without intimal

dissection and a visible flap. Intra Vascular Ultrasound (IVUS) and Optical Coherence Tomography (OCT) are helpful

modalities for diagnosis and evaluation of its extension. We present a case in which coronary occlusion developed due to

an intramural hematoma after an elective Percutaneous Coronary Intervention (PCI) to the mid left circumflex artery. The

patient was clinically asymptomatic after the angioplasty, but his highly sensitive troponins were trending very high and had

two short runs of ventricular tachycardia. We did a relook angiography the next day and it showed new hazy 80% stenosis

from the distal end of the newly implanted stent. In view of likely dissection, we decided to do OCT to identify the etiology of

the new lesion. We choose OCT as it offers clear, high resolution images, compared to grainy, lower resolution IVUS images.

Moreover, OCT provides a complete vessel wall assessment and can reveal more insight into the mechanisms of intramural

hematomas like the entry point of the dissection, propagation direction, underlying arterial plaque, severity of the intramural

hematoma and luminal compromise. OCT confirmed an edge dissection at the distal end of the stent, which created a big

intramural hematoma compressing the true lumen. We decided to perform angioplasty, as the patient had two short runs of

ventricular tachycardia and high sensitive troponin T was highly elevated. Direct stenting was performed using drug eluting

stent overlapped with distal end of the previous stent covering the edge dissection. The inflation pressure was kept low at 10

atm for 17 seconds. Post dilation was performed only at the stent overlapped area using a Quantum 3.5 x 8 mm non-compliant

balloon at a pressure of 16 atm for 16 seconds. Following the intervention there was 0% stenosis with TIMI 3 flow. Post stenting

OCT (Optical Coherence Tomography) showed complete resolution of the intra mural hematoma and edge dissection, with

well apposed stents. The patient was discharged after few days in a very good condition and his clinical outcomes were excellent

at one month after intervention.


Muhammed Jameesh Moidy is a currently 3rd year Cardiology ACGMI accredited Fellowship program scholar at the Heart Hospital, Qatar. His re-

search interest is in coronary artery disease root cause analysis, prevention and better long-term patient outcome. He has her expertise in evaluation

and passion in improving the health and well-being by introducing innovative technologies in the field of intervention cardiology.

[email protected]

Muhammed Jameesh Moidy

HMC Heart Hospital, Qatar

Muhammed Jameesh Moidy, Curr Res Cardiol 2018, Volume 5

DOI: 10.4172/2368-0512-C1-001