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The "Cuttering (Cutting-Dottering Balloon) Technique" for treatment of flow-limiting coronary intramural hematoma
Gabriele Luigi Gasparini1, Matteo Maurina1,2, Damiano Regazzoli1
1Division of Invasive Cardiology, Cardio Center, IRCCS Humanitas Research Hospital, Milan, Italy.
Insights
The "Cuttering Technique" effectively manages intramural hematomas (IMH) after coronary artery dissection. This method creates intimal tears to drain hematomas and restore blood flow, improving outcomes in percutaneous coronary intervention.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Surgery
Background:
- Coronary artery dissections involve a tear in the endothelium, leading to blood accumulation in the subintimal space, forming an intramural hematoma (IMH).
- Cutting balloons, a potential treatment for IMH, can cause distal hematoma propagation.
- A novel technique is presented to address this complication.
Purpose of the Study:
- To describe and evaluate a novel technique for managing flow-limiting intramural hematomas (IMH) complicating percutaneous coronary intervention.
- To assess the efficacy of the
- Cuttering Technique
- in restoring distal coronary flow.
Main Methods:
- A retrospective analysis of seven consecutive patients with flow-limiting IMH after percutaneous coronary intervention was conducted.
- All patients were treated with the "Cuttering Technique".
Main Results:
- The
- Cuttering Technique
- successfully restored Thrombolysis in Myocardial Infarction 3 (TIMI 3) flow in five out of seven patients.
- Complete restoration of TIMI 3 flow was observed in the dissected segment in these patients.
Conclusions:
- The
- Cuttering Technique
- is a viable approach for managing intramural hematomas (IMH).
- This technique facilitates hematoma drainage by creating intimal tears between the false and true lumens.
- It aids in restoring distal coronary flow following dissection complications.
Background:
Coronary artery dissections are caused by a tear in the vessel endothelium, resulting in blood extravasation into the subintimal space, with subsequent intramural hematoma (IMH). One potential technique to deal with this complication is the use of cutting balloons, however, a significant number of cases experienced distal propagation of the hematoma. We describe a novel technique that enhances the possibility of creating intimal tears between the false and true lumen, aiding in hematoma drainage and restoring distal coronary flow.
Methods:
We conducted a retrospective analysis of seven consecutive patients who underwent percutaneous coronary intervention complicated by flow-limiting intramural hematomas. All patients were treated using the "Cuttering Technique," based on the operators' preference. Procedural success was defined as achieving a distal thrombolysis in myocardial infarction 3 (TIMI 3) flow.
Results:
In five out of seven patients treated with "Cuttering Technique" we observed a complete restoration of TIMI 3 flow into the dissected segment.
Conclusions:
Our cases show the effectiveness of the "Cuttering Technique" as a viable approach for managing IMHs. This technique enhances the possibility of creating intimal tears between the false and true lumens, aiding in hematoma drainage and restoring distal coronary flow.
