Key result
IVUS-guided stenting successfully treats extensive post-PCI intramural hematoma and restores TIMI III flow.
Why the study?
Post-PCI STEMI is not always caused by acute stent thrombosis and can result from extensive coronary intramural hematoma.
Case Report (n=1)
No
This case report demonstrates that acute post-PCI STEMI can be caused by a dissecting coronary intramural hematoma rather than stent thrombosis, highlighting the essential role of intravascular ultrasound (IVUS) in making an accurate diagnosis and guiding successful bailout stenting.
IVUS may differentiate intramural hematoma from thrombosis in post-PCI STEMI; leaves open prospective validation of this bailout approach.
Case reportdirected medical therapy.Diagnostic coronary angiography (CAG) revealed two-vessel disease involving the LAD and the RCA.The patient subsequently underwent percutaneous transluminal coronary angioplasty (PTCA).The LAD lesion was treated with a 2.75 × 28 mm sirolimus-eluting stent (SES).The RCA was revascularized with a 3.0 × 32 mm SES deployed from the ostium of the vessel.One hour following the procedure, the patient developed recurrent severe angina.A repeat 12-lead electrocardiogram (ECG) demonstrated acute ST-segment elevations in leads II, III, and aVF, diagnostic of an acute inferior wall STEMI (Fig. 1).Given the acute post-PCI presentation, acute stent thrombosis was strongly suspected.1 The patient was immediately transferred back to the catheterization laboratory for emergency re-look CAG, which demonstrated an occluded RCA from its mid portion (Fig. 2).
No takes yet. Share an insight, caveat, or question.
Chirde et al. (2026) conducted a case report in Acute inferior wall STEMI 1 hour post-PCI caused by an extensive dissecting coronary intramural hematoma (n=1). Intravascular ultrasound (IVUS)-guided overlapping sirolimus-eluting stent (SES) implantation was evaluated on Hematoma compression, restoration of TIMI III flow, and resolution of angina and ST-segment elevations. IVUS-guided deployment of two overlapping sirolimus-eluting stents successfully compressed an extensive post-PCI RCA intramural hematoma, restoring TIMI III flow and resolving acute STEMI.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: