Stenting of spontaneous coronary intramural haematoma carries a risk of haematoma propagation, which may necessitate the use of undersized stents to prevent further progression.
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Stenting spontaneous intramural haematoma risks propagation; hypothesis-generating for undersized stents, larger studies needed before practice change.
A 57-year-old woman with history of hypertension was admitted to the coronary care unit with acute coronary syndrome without ST-segment elevation. Coronary angiography showed an eccentric and severe lesion at the mid-segment of the left anterior descending (LAD) coronary artery. Intravascular ultrasound (IVUS) showed a spontaneous dissection with intramural haematoma (Panel A), which was treated with a 3.0 × 28 mm paclitaxel eluting-stent direct implantation. After stent placement, an angiographically severe stenosis was observed proximally to the stent. IVUS demonstrated a huge coronary intramural haematoma (Panel B). At that moment, the patient had severe chest paint with ST elevation. Afterwards, two paclitaxel eluting-stents (3.5 × 18 and 3.5 × 16 mm) were deployed at the level of the haematoma to attempt to hold the occlusive haemorrhage. We decided to implant smaller stents than the reference diameter of the coronary artery in order to prevent the progression of the haematoma (Panel C).
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Sánchez‐Recalde et al. (2008) studied this question.
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