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Coronary Artery Occlusion Caused by Intramural Hematoma Due to In-Stent Dissection

Yasushi Ueki1, Lorenz Räber1, Raminta Kavaliauskaite1

  • 1Department of Cardiology, Bern University Hospital, Bern, Switzerland.

JACC. Case Reports
|July 28, 2021
PubMed

Insights

In-stent dissection after percutaneous coronary intervention can lead to intramural hematoma and coronary artery occlusion. This case highlights a rare complication of a typically benign finding, emphasizing the need for careful monitoring.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Medical Imaging

Background:

  • Percutaneous coronary intervention (PCI) is a common procedure for coronary artery disease.
  • In-stent dissection is a frequent finding during PCI, often considered benign.
  • Complications from in-stent dissections can occur, though rarely.

Purpose of the Study:

  • To report a case of ST-segment elevation myocardial infarction (STEMI) secondary to in-stent dissection.
  • To illustrate the potential for in-stent dissection to cause intramural hematoma and coronary occlusion.
  • To emphasize the importance of advanced imaging in diagnosing PCI complications.

Main Methods:

  • A 54-year-old male patient presented with STEMI.
  • Emergent PCI was performed on the left anterior descending artery.
  • Optical coherence tomography (OCT) was utilized for in-situ imaging during PCI.

Main Results:

  • OCT revealed an intramural hematoma originating from an in-stent dissection.
  • The intramural hematoma extended and led to coronary artery occlusion.
  • The patient experienced STEMI one week post-PCI.

Conclusions:

  • In-stent dissection, while often benign, can progress to serious complications.
  • Intramural hematoma formation is a potential sequela of in-stent dissection.
  • OCT is crucial for identifying and characterizing such complications during PCI.

Keywords:
LAD, left anterior descending arteryOCT, optical coherence tomographyPCI, percutaneous coronary interventionacute myocardial infarctiondissectionintramural hematomaoptical coherence tomographypercutaneous coronary intervention

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