Left main coronary intramural hematoma can progress despite initial conservative management, warranting urgent surgical revascularization for proximal involvement or worsening ischemia.
Coronary intramural hematoma is a rare cause of ACS where multimodal imaging is essential, and while conservative management is preferred, surgical revascularization is warranted for proximal involvement or ischemic progression.
Absolute Event Rate: 0% vs 0%
A 46‐year‐old woman with no cardiovascular risk factors presented with self‐limiting chest pain. Electrocardiography was normal, but high‐sensitivity cardiac Troponin I was elevated. Echocardiography demonstrated preserved biventricular function. Coronary angiography revealed reduced distal caliber of the left main coronary artery (LMCA), and intravascular ultrasound (IVUS) confirmed a coronary intramural hematoma (CIH). With preserved flow and clinical stability, conservative therapy with aspirin, beta‐blocker, and statin was initiated. On Day 13 of hospitalization, coronary computed tomography (CT) and angiography showed progression of the hematoma with severe LMCA stenosis. The heart team opted for urgent surgical revascularization using bilateral internal mammary artery grafts to the left anterior descending and obtuse marginal arteries. Recovery was uneventful. CIH is a rare cause of acute coronary syndrome (ACS), often linked to spontaneous coronary artery dissection (SCAD) and systemic arteriopathy. Multimodal imaging is essential for diagnosis and follow‐up. Although conservative management is preferred in stable cases, surgery is warranted for proximal involvement or progression of ischemia.
Martínez-Fleta et al. (Thu,) reported a other. Left main coronary intramural hematoma can progress despite initial conservative management, warranting urgent surgical revascularization for proximal involvement or worsening ischemia.