A Bleeding Kiss: intramural haematoma secondary to balloon angioplasty

Cheerag Shirodaria,Adrian P Banning,William J Van Gaal

doi:10.1186/1476-7120-5-21

Cheerag Shirodaria, Adrian P Banning + Show 1 more

Open Access

https://doi.org/10.1186/1476-7120-5-21

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Journal: Cardiovascular ultrasound	Publication Date: Jun 5, 2007
Citations: 10	License type: cc-by

Affiliation: John Radcliffe Hospital

Abstract

BackgroundIntramural coronary haematoma following percutaneous coronary intervention in the absence of coronary dissection is a rare phenomenon.Case presentationA 69 year old lady with previous prosthetic aortic valve replacement underwent percutaneous coronary intervention (PCI) from the left mainstem to the left anterior descending artery (LAD) and kissing balloon inflations to the LAD and circumflex (Cx) arteries. Although intravascular ultrasound examination (IVUS) of both the LAD and Cx showed both vessels to be widely patent at the end of the procedure, she developed ischaemic chest pain six hours later. Repeat coronary angiography revealed a significant stenosis in the proximal Cx vessel, which was confirmed on IVUS to be intramural haematoma.ConclusionIn patients taking warfarin in addition to standard antiplatelet therapy, kissing balloon inflations should be carried out with caution.

Highlights

Intramural coronary haematoma following percutaneous coronary intervention in the absence of coronary dissection is a rare phenomenon.Case presentation: A 69 year old lady with previous prosthetic aortic valve replacement underwent percutaneous coronary intervention (PCI) from the left mainstem to the left anterior descending artery (LAD) and kissing balloon inflations to the LAD and circumflex (Cx) arteries
Intramural haematoma in a coronary artery is a rare complication of percutaneous coronary intervention
A 16 mm Liberte (Boston Scientific) stent was deployed from the left mainstem (LMS) into the LAD, crossing the Cx ostium

Summary

Introduction

Intramural coronary haematoma following percutaneous coronary intervention in the absence of coronary dissection is a rare phenomenon.Case presentation: A 69 year old lady with previous prosthetic aortic valve replacement underwent percutaneous coronary intervention (PCI) from the left mainstem to the left anterior descending artery (LAD) and kissing balloon inflations to the LAD and circumflex (Cx) arteries. Conclusion: In patients taking warfarin in addition to standard antiplatelet therapy, kissing balloon inflations should be carried out with caution. Intramural haematoma in a coronary artery is a rare complication of percutaneous coronary intervention. Haemorrhage commonly occurs due to subintimal dissection without a flap or reentry.[1,2] haematoma in the absence of coronary dissection with an intact media is rare. Coronary angiography and intravascular ultrasound (IVUS) examination revealed a critical ostial stenosis in the native LAD (figure 1, panels A&B), with only a small amount of retrograde flow from the LIMA into the native LAD.

Results

Conclusion