Related Experiment Video
Updated: Mar 6, 2026
Catheter-based Endovascular Angioplasty for Fibrosing Mediastinitis-associated Pulmonary Vein Stenosis
Published on: August 26, 2025
Compressive Coronary Hematoma in an Elderly Woman Receiving Oral Anticoagulation Treated With Cutting Balloon
Kais Ouerghi1, Victor Mateus1, Tahar Lazizi1
1Department of Interventional Cardiology, Laval Hospital, Laval, France.
Background:
Intramural hematoma (IMH) is an uncommon cause of acute coronary syndrome and may occur in elderly patients with vascular fragility receiving oral anticoagulation.
Case Summary:
A 75-year-old woman on anticoagulation presented with inferior ST-segment elevation myocardial infarction. Angiography showed posterolateral branch occlusion and distal right coronary artery narrowing. Optical coherence tomography (OCT) revealed a 360° compressive posterolateral branch IMH (minimal lumen area: 0.60 mm2) and a noncompressive distal right coronary artery IMH (330° arc; minimal lumen area: 4.6 mm2). OCT-guided cutting balloon fenestration in the posterolateral branch (3 inflations, 16 bar) restored TIMI flow grade 3 without stenting. On day 3, complete atrioventricular block with pauses of >7 seconds led to permanent pacemaker implantation. Systematic angiography on day 5 showed silent distal right coronary artery IMH extension, prompting anticoagulation discontinuation. At 3 months, complete healing was observed, followed by left atrial appendage closure. No events occurred during the 4-year follow-up.
Discussion:
Selective OCT-guided fenestration enabled durable revascularization without stent implantation.
Take-Home Message:
Cutting balloon fenestration provides favorable long-term outcomes in compressive IMH.
