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Coronary Artery Hematoma Treated with Fenestration Using a Novel NSE Alpha® Scoring Balloon
Naohiro Funayama1, Takao Konishi1, Tadashi Yamamoto1
1Hokkaido Cardiovascular Hospital, Hokkaido, Japan.
Insights
Coronary intramural hematoma management remains undefined. Fenestration with a scoring balloon successfully treated a case of coronary occlusion after PCI, avoiding further stenting.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- Optimal management strategies for coronary intramural hematoma (CIH) are not well-established.
- Percutaneous coronary intervention (PCI) can precipitate complications like CIH.
- Left circumflex artery (LCX) interventions carry specific risks.
Observation:
- A case of acute coronary occlusion due to CIH following mid-LCX PCI is presented.
- Intravascular ultrasound (IVUS) imaging revealed progressive CIH and complete compression of the true lumen.
- The hematoma significantly compromised coronary blood flow.
Findings:
- A novel approach utilizing fenestration with a scoring balloon (NSE Alpha, Goodman, Japan) was employed.
- This technique successfully decompressed the true lumen by creating fenestrations in the hematoma.
- The procedure avoided the need for additional stent deployment.
Implications:
- Fenestration with a scoring balloon offers a safe and effective alternative for managing CIH.
- This approach may prevent further complications associated with additional stenting.
- This case highlights a potential minimally invasive strategy for a challenging PCI complication.
Abstract:
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.
