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[Subepicardial hematoma (haemorrhagia per rhexin) after elective PTCA with consecutive compression of the distal
1Abteilung für Kardiologie, Universitätskrankenhauses Hamburg-Eppendorf.
A transmural coronary dissection occurred immediately after elective angioplasty of a 90% stenosis of the proximal left anterior descending coronary artery (LAD) within the dilated segment and was followed by subepicardial bleeding (haemorrhagia per rhexin), although no perforation by the guide-wire or the balloon catheter took place. A subepicardial blood bolster led to rapid extravasal compression of the LAD distal from the PTCA site resulting in acute ischemia. None of the conventional rescue-interventions such as stents or autoperfusion catheters were likely to resolve this critical situation and the patient successfully underwent emergency bypass surgery.
A transmural coronary dissection occurred immediately after elective angioplasty of a 90% stenosis of the proximal left anterior descending coronary artery (LAD) within the dilated segment and was followed by subepicardial bleeding (haemorrhagia per rhexin), although no perforation by the guide-wire or the balloon catheter took place. A subepicardial blood bolster led to rapid extravasal compression of the LAD distal from the PTCA site resulting in acute ischemia. None of the conventional rescue-interventions such as stents or autoperfusion catheters were likely to resolve this critical situation and the patient successfully underwent emergency bypass surgery.