Cardiac Computed Tomography to Identify and Guide Therapy of Intramural Hemorrhage in High-Risk Coronary Anatomy

Figures

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  Figure 1. Initial Presentation Intramural hemorrhage (IMH) delineated by computed tomography (CT) coronary angiogram (CTCA) and corresponding invasive coronary angiogram with intravascular ultrasound (IVUS) and coronary artery lesion characterization. Curved multiplanar reformat views of left main (LM) and left anterior descending (A), LM and left circumflex artery (B), and right coronary artery (C) show significant high-risk anatomy lesion as single-vessel LM disease (arrow). Invasive coronary angiogram (D and E) proves the CTCA findings and delineates the significant corresponding LM lesion (arrow). IVUS shows the complex lesion around LM with color-coding extravascular component (F) and monochrome delineation (G) with intact intimal border. Multiplanar reformat CTCA images showing low-attenuation core and the lesion within the vessel wall (arrows) (H). CTCA 10 mm from the LM ostium shows the corresponding LM vessel lumen with complex, heterogenous component within the lesion (I). The low-attenuation area (arrow) was covered and sealed by the intimal compartment. Color-coded tissue characterization (J) revealed a low-attenuation component suggestive of IMH coded using red color; vessel…

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  Figure 2. Follow-Up Presentation Resolution of IMH delineated using CTCA and corresponding coronary artery lesion characterization. Repeated CTCA in 3 months (A and B) shows significant resolution of LM lesion and disappearance of low-attenuation, hemorrhagic component. Only mild residual intimal thickening confirmed in the exact same area (10 mm distal to LM ostium) (C and D) depicted by the corresponding tissue characterization graph (E) showing a prominent reduction in the volume of hematoma to 0.25 mm3 (which represents 1% relative to the entire lesion volume). Abbreviations as in Figure 1.