Author + information
- Received May 21, 2013
- Accepted June 21, 2013
- Published online March 1, 2014.
- Shinji Inaba, MD∗,†,
- Gary S. Mintz, MD∗,
- Michael B. Collins, MD∗,†,
- Khady N. Fall, MD∗,†,
- Jeffrey W. Moses, MD∗,† and
- Akiko Maehara, MD∗,†∗ ()
- ∗Cardiovascular Research Foundation, New York, New York
- †Columbia University Medical Center, New York, New York
- ↵∗Reprint requests and correspondence:
Dr. Akiko Maehara, Cardiovascular Research Foundation, 111 East 59th Street, 12th Floor, New York, New York, 10022.
A 53-year-old woman was admitted for unstable angina pectoris. Coronary angiography revealed a stenosis in the right coronary artery (Fig. 1A). A 2.75- × 18-mm zotarolimus-eluting stent was implanted at 16 atm. Intravascular ultrasound showed a distal edge dissection (Fig. 1C), which appeared to extend beyond the media with a lumen of 5.8 mm2 and TIMI (Thrombolysis In Myocardial Infarction) flow grade 3 (Fig. 1B).
Sustained chest pain occurred 3 h after the procedure. Emergent angiography revealed flow-limiting obstruction at the distal stent edge (Fig. 2). Optical coherence tomography showed a hematoma (hypo-backscattering with attenuation) that was clearly located outside of the media, but inside of the adventitia (Fig. 3). Intravascular ultrasound also demonstrated the development of an extramedial hematoma. The mechanism is shown in Figure 4.
We report a progression from dissection to extramedial hematoma. Optical coherence tomography can localize a post-stent hematoma as intramedial or extramedial.
Dr. Mintz has received grant support and consulting fees from Boston Scientific Corporation, InfraRedX, St. Jude Medical, and Volcano Corporation. Dr. Moses has received consulting fees from Boston Scientific Corporation. Dr. Maehara has received grant support and consulting fees from Boston Scientific Corporation. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received May 21, 2013.
- Accepted June 21, 2013.
- American College of Cardiology Foundation