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Volume 5 Journal of Current Research: Cardiology Heart Congress 2018
November 21-22, 2018
Page 16
2nd Global Heart Congress
November 21-22, 2018 Osaka, Japan
Post PCI coronary intramural hematoma causing NSTEMI and short runs of VT
The 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.
Biography
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.
Muhammed Jameesh Moidy
HMC Heart Hospital, Qatar
Muhammed Jameesh Moidy, Curr Res Cardiol 2018, Volume 5
DOI: 10.4172/2368-0512-C1-001