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12.09.2019 | Images in CV Applications

Intramural hematoma squeeze causing carina shift during stent deployment. A preventable complication of coronary artery dissection treatment?

verfasst von: Francesco Gallo, Antonio Mangieri, Alessandra Laricchia, Andrea Fisicaro, Antonio Colombo, Francesco Giannini

Erschienen in: The International Journal of Cardiovascular Imaging

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Excerpt

68-years old woman with a clinical history of arterial hypertension and dyslipidemia even affected by moderate renal impairment (eGFR 40 ml/min). Since two months she complained dyspnoea due to physical effort, since three days before she complained also chest pain at rest. EKG and cardiac enzymes didn’t show any sign of acute ischemia. She was admitted at our catheterization laboratory for coronary angiography. The right coronary artery was patent without significant disease. Mild stenosis at left anterior descending (LAD) at the level of the first bifurcation with 2nd diagonal (Fig. 1a). To better investigate that lesion we performed OCT on the LAD and 2nd Diag. The lesion shows up as a sickle-shaped and dark image between media and adventitia; at the intima wall an endothelial discontinuation can be appreciated (Fig. 1b). That image could be referred to an intramural hematoma. Because of the severity of the obstruction (MLA 3.3 cm2) we decided to proceed to PCI. We performed a pre-dilation with a semi-compliant balloon, followed by a 3.5 × 18 mm DES implantation. After DES implantation we observed a side branch occlusion (Fig. 1c), probably due to a hematoma “squeeze”. Stent implantation, without adequate lesion preparation, may have been propagate the hematoma toward the side branch, determining it’s suffering. We wired the side branch and we proceeded to predilate end than, a kissing balloon was performed (Fig. 1d). Then, we performed Intravascular ultrasound (IVUS) in order to minimize contrast media injections (renal impairment). IVUS showed the hematoma against the arterial wall, crushed by the stent (Fig. 1e). The final angiographic result was acceptable (Fig. 1f), the patient remained asymptomatic and she was discharged after 2 days.
Metadaten
Titel
Intramural hematoma squeeze causing carina shift during stent deployment. A preventable complication of coronary artery dissection treatment?
verfasst von
Francesco Gallo
Antonio Mangieri
Alessandra Laricchia
Andrea Fisicaro
Antonio Colombo
Francesco Giannini
Publikationsdatum
12.09.2019
Verlag
Springer Netherlands
Erschienen in
The International Journal of Cardiovascular Imaging
Print ISSN: 1569-5794
Elektronische ISSN: 1875-8312
DOI
https://doi.org/10.1007/s10554-019-01694-7

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