Compressive Coronary Hematoma Treated With Stenting: From Early Malapposition to 9-Year Recovery in Systemic Disease

Spontaneous coronary artery dissection (SCAD) may require revascularization when severe ischemia results from compressive intramural hematoma.

A 38-year-old woman presented with anterior ST-segment elevation myocardial infarction caused by a long compressive intramural hematoma of the left anterior descending artery. Optical coherence tomography (OCT) demonstrated a 41-mm Type 2a SCAD with severe true lumen compression (minimal lumen area 0.6 mm²). Percutaneous coronary intervention with a total stented length of approximately 60 mm restored TIMI flow grade 3. At 1 month, OCT showed proximal stent malapposition measuring 1.2 mm in depth over a 12-mm segment with positive vessel remodeling (minimal lumen area 7.41 mm²; diameter 3.06 mm). At 2 months, repeat OCT demonstrated partial spontaneous correction (600 μm over 8 mm), followed by OCT-guided postdilation restoring full stent apposition. Two years later, a Type 1 left main SCAD required stenting. Multimodality imaging revealed fibromuscular dysplasia. At 9-year follow-up, no recurrent coronary events occurred and left ventricular ejection fraction improved to 60%.

Serial OCT demonstrates dynamic vessel remodeling after compressive SCAD and highlights the value of imaging-guided management when long-segment stenting is required.