Intravascular ultrasound-guided troubleshooting in a large hematoma treated with fenestration using a cutting balloon

Compressive Coronary Intramural Hematoma: A Case Report

Despite the advancement of various devices and techniques, percutaneous coronary intervention (PCI) of chronic total occlusion (CTO) lesion remains one of the major challenges in interventional cardiology fields. It is also associated with higher complications than non-CTO-PCI due to procedural complexity. We presented a case of iatrogenic compressive coronary intramural hematoma (IMH) as CTO-PCI complications, which was judiciously detected and successfully managed with a cutting balloon.

Fenestration using a novel cutting balloon for acute vessel occlusion secondary to intramural hematoma following stent implantation

Intramural hematoma after percutaneous coronary angioplasty is associated with adverse events and requires immediate bail out; however, the optimal treatment approach has not yet been established. Herein, we describe a case of coronary occlusion due to an intramural hematoma following stent implantation in the mid left anterior descending (LAD) coronary artery. Intravascular ultrasound revealed a massive intramural hematoma from the distal edge of the stent to the distal segment of the LAD, and the true lumen was completely compressed. By performing fenestration with a Wolverine™ Cutting Balloon™ (Boston Scientific, Massachusetts, United States), we were able to bail out without additional stenting. In conclusion, a cutting balloon with improved crossability can be an effective management strategy for intramural hematoma.

Aspiration After Sealing the Entrance by Stenting Is a Promising Method to Treat Subintimal Hematoma

Creation of a distal re-entry site is widely performed to treat subintimal hematoma. However, this method has a risk of further vessel damage. The present aspiration technique after sealing the entry site by stenting is more promising because the hematoma can be reduced without additional vessel damage. (Level of Difficulty: Advanced.)

Rare complication of subacute renal artery intramural haematoma after renal artery stenting: a case report

Background

Renal artery intramural haematoma (IMH) is a rare cause of renal artery obstruction after stenting. Diagnosis and treatment are difficult as there are only a few cases reported.

Case summary

We present the case of sudden-onset abdominal pain and non-functional kidney 3 days after renal artery stent implantation. Subacute luminal narrowing of the renal artery was initially diagnosed using computed tomography angiography and renal artery angiography, and a final diagnosis of subacute renal artery IMH was made using intravascular ultrasound (IVUS). Subsequently, the patient was treated with percutaneous transluminal angioplasty from far to near and another stent implantation. At the third month follow-up, blood pressure and renal function were normal.

Discussion

This case suggests that IVUS could be useful for qualifying and treating the subacute renal artery IMH.

A Case of an Obstructive Intramural Haematoma during Percutaneous Coronary Intervention Successfully Treated with Intima Microfenestrations Utilising a Cutting Balloon Inflation Technique

During percutaneous coronary interventions (PCI), good lesion preparation with adequate balloon predilatation is a fundamental step before stent deployment in order to achieve optimal stent expansion and favourable long-term outcomes post PCI. During PCI, inadvertent vessel tearing can occur, resulting in coronary dissections and formation of intramural haematomas. The latter might be associated with compression of the vessel lumen and significant compromise of the coronary blood flow leading to myocardial ischaemia and infarction. Herein, we present a case of intramural haematoma that occurred after PCI of the left anterior descending artery resulting in occlusion of the vessel and the subsequent use of a cutting balloon inflation technique to resolve the haematoma and restore the normal coronary blood flow.

Coronary Artery Hematoma Treated with Fenestration Using a Novel NSE Alpha® Scoring Balloon

The optimal management of coronary intramural hematoma has not been defined. We described a case in which coronary occlusion developed due to an intramural hematoma after percutaneous coronary intervention for mid left circumflex artery (LCX). Intravascular ultrasound (IVUS) demonstrated the progression of the intramural hematoma and a totally compressed true lumen. Our approach was based on fenestration with a scoring balloon (NSE Alpha, Goodman, Japan), which allowed the deployment of an additional stent to be avoided. In conclusion, this management can be effectively and safely performed.

Coronary artery fenestration prior to stenting in spontaneous coronary artery dissection

Percutaneous coronary intervention (PCI) in patients with spontaneous coronary artery dissection is associated with high rates of complications and suboptimal long-term outcomes. Coronary artery fenestration with cutting balloon angioplasty prior to stenting can prevent the expansion of intramural hematoma and optimize PCI outcomes in this patient population. © 2015 Wiley Periodicals, Inc.

A case of intra- and extra-mural hematomas during recanalization for chronic total occlusion

An intramural hematoma is an accumulation of blood between the internal and external elastic membranes within the medial space, whereas an extramural hematoma is a dilution and/or dissemination of blood throughout the adventitia. Intra- and extra-hematomas are observed by intravascular ultrasound during percutaneous coronary intervention (PCI). The patient described herein presented with angina pectoris. Her coronary angiogram showed diffuse narrowing of the mid-left anterior descending artery and total occlusion of the distal right coronary artery (RCA). Intra- and extra-mural hematomas developed during PCI of the RCA; however, the lesions were covered successfully using long drug-eluting stents.