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Intramyocardial Hematoma After Percutaneous Coronary Intervention for Chronic Total Occlusion: Two Case Reports

Xuefei Mu1, Ziqi Li1, Quanmin Jing1

  • 1State Key Laboratory of Frigid Zone Cardiovascular Disease, Cardiovascular Research Institute and Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China.

Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions
|April 15, 2025
PubMed

Insights

Intramyocardial hematoma (IMH) is a rare complication during percutaneous coronary intervention (PCI) for chronic total occlusion (CTO). Avoiding catheter pressure entrapment and high-dose angiography can prevent severe outcomes like pericardial tamponade.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiac Surgery

Background:

  • Percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) presents significant technical challenges.
  • Intramyocardial hematoma (IMH) is a rare but severe complication associated with PCI for CTO.

Observation:

  • This report details two cases of IMH during right coronary artery (RCA) CTO recanalization.
  • Both cases involved risky factors: catheter pressure entrapment and high-dose antegrade angiography.

Findings:

  • One patient developed pericardial tamponade secondary to IMH, requiring surgical intervention.
  • The other patient experienced hypotension due to IMH, managed conservatively as the hematoma was not pericardial.

Implications:

  • Highlights the critical importance of avoiding specific procedural techniques during PCI for CTO.
  • Emphasizes prompt diagnosis and tailored management strategies for IMH based on its extent and impact.

Keywords:
ACS—acute coronary syndromeANCO—angiographyCTOCTO—percutaneous coronary interventioncoronary

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