Cutting-balloon fenestration restored TIMI 3 flow in 73% of patients with flow-limiting coronary dissections and intramural haematoma, avoiding additional stenting in 36% of cases.
Does cutting-balloon fenestration improve angiographic flow in patients with coronary dissections and intramural haematoma?
Cutting-balloon fenestration is a feasible technique that achieves a high rate of flow restoration and allows for stent avoidance in flow-limiting intramural haematomas.
Absolute Event Rate: 0% vs 0%
Abstract Introduction Coronary dissections with intramural haematoma may be spontaneous or an uncommon yet potentially serious complication of percutaneous coronary intervention (PCI). These lesions can compromise distal flow and cause ischaemia. Conventional management with drug-eluting stents (DES) can propagate the haematoma and occlude side branches. Cutting-balloon dilatation (CB) has been proposed to create fenestrations between the true and false lumens, allowing decompression of the haematoma and restoration of coronary flow without further stenting. Objective To describe the efficacy and safety of cutting-balloon fenestration for coronary dissections with intramural haematoma and impaired flow, assessing immediate angiographic and procedural results. Methods We performed a retrospective observational study of consecutive cases at a tertiary centre. We included all patients with coronary dissection, TIMI flow ≤2, and suspected intramural haematoma treated with a cutting balloon between January 2020 and October 2025. Cutting balloons 2.0–3.0 mm in diameter and 10–15 mm in length were inflated at low pressure across the affected segment. Angiographic success was defined as restoration to TIMI 3 flow without perforation or dissection progression. Results Eleven patients were analyzed; 36.4% were women and 63.6% men. Clinically, NSTE-ACS predominated (90%), while STEMI accounted for 9%. Regarding mechanisms, most dissections were iatrogenic: 64% after balloon predilation, 18% catheter-related (contrast injection or guide catheter manipulation), 9% during wire advancement, and 9% were spontaneous (SCAD). By classification, type C was most frequent (36%), followed by B (27%), D (18%), E (9%), and F (9%). The most involved territories were the right coronary artery (proximal/mid) and the left anterior descending artery; no vessel had been previously treated. Baseline flow was TIMI 0 in 36% and ≤2 in 64%. After CB dilation, TIMI 3 flow was achieved in 73. Additional stent implantation was avoided in 36%. Complications were infrequent: only 1 cased presented a contained perforation. No other intraprocedrual events were observed. Conclusions In this series, cutting-balloon fenestration achieved a high rate of flow restoration with a favourable safety profile in flow-limiting intramural haematomas, allowing stent avoidance in a substantial proportion of cases. While consistent with prior reports, larger prospective studies with longer follow-up are needed to confirm efficacy and refine indications.
Faria et al. (Sun,) reported a other. Cutting-balloon fenestration restored TIMI 3 flow in 73% of patients with flow-limiting coronary dissections and intramural haematoma, avoiding additional stenting in 36% of cases.