Coronary artery fenestration as rescue management of intramural haematoma with luminal compression

Area of Science:

• Cardiology
• Interventional Cardiology
• Medical Imaging

Background:

• Spontaneous coronary artery dissection (SCAD) is a rare condition, often affecting younger individuals, characterized by a tear in the coronary artery wall.
• While conservative management is standard for stable SCAD, recurrent ischemia or hemodynamic instability may necessitate revascularization.
• Intramural hematoma with significant luminal compression presents a complex challenge in SCAD management.

Observation:

• A case of SCAD with severe luminal compression due to intramural hematoma is presented.
• The patient required intervention due to recurrent ischemia and hemodynamic instability.
• Optical coherence tomography (OCT) was utilized for detailed imaging of the coronary artery dissection.

Findings:

• Successful percutaneous coronary intervention (PCI) was achieved using an optical coherence tomography (OCT)-guided approach.
• A cutting balloon was employed for fenestration at multiple decompression sites within the intramural hematoma.
• Stenting was performed following successful fenestration, restoring coronary blood flow.

Implications:

• This case highlights a potential novel technique for managing complex SCAD cases with luminal compression.
• OCT-guided PCI with fenestration and stenting may offer a viable rescue strategy when conservative measures fail.
• Further research is needed to evaluate the procedural success rates and long-term outcomes of this technique in a larger cohort.