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Fenestration using a scoring balloon Scoreflex® as troubleshooting for acute vessel closure due to intramural
Yoshiyuki Okuya1, Kenichi Fukushima, Yasuhiko Hori
1Department of Cardiovascular Medicine, Matsudo City Hospital, Matsudo, Japan, yoshiyuki09857@gmail.com.
Insights
A scoring balloon successfully treated coronary intramural hematoma after angioplasty, restoring blood flow. This technique created a fenestra, improving outcomes in a complex left circumflex artery intervention.
Area of Science:
- Interventional Cardiology
- Vascular Biology
- Medical Device Technology
Background:
- Coronary intramural hematoma can cause luminal narrowing after balloon angioplasty.
- Standard stenting may not always restore adequate coronary blood flow in such cases.
Observation:
- A patient experienced persistent flow limitation post-angioplasty due to coronary intramural hematoma.
- A stent placement did not resolve the compromised coronary flow.
Findings:
- Utilizing a scoring balloon (Scoreflex®) created a fenestra between the true lumen and the hematoma.
- This intervention restored Thrombolysis In Myocardial Infarction (TIMI) grade 3 flow.
- Angiography revealed a long dissection extending from the stent to the scored area.
Implications:
- Scoring balloons offer a potential solution for managing complex coronary dissections and hematomas.
- This approach may improve procedural success rates in challenging coronary interventions.
- Long-term follow-up confirmed sustained patency and good coronary flow after the intervention.
Abstract:
This case report demonstrated the usefulness of scoring balloon when luminal narrowing occurred after balloon angioplasty in the left circumflex artery due to coronary intramural hematoma. Although a stent was placed, coronary flow was not improved. We intended to make a fenestra between the true lumen and the hematoma using a scoring balloon (Scoreflex® 2.0 × 10 mm, OrbusNeich, Tokyo, Japan) which was dilated in the distal segment of the branch. Angiograms showed restoration of TIMI-3 flow with a long dissection spanning from distal of the stent to the scored area. After 3 months and 1 year, follow-up coronary angiograms demonstrated occluded false lumen and good coronary flow in the treated vessel.
