Incidence, morphology, angiographic findings, and outcomes of intramural hematomas after percutaneous coronary interventions - An intravascular ultrasound study

Background-Intramural hematomas during percutaneous coronary intervention (PCI) have not been well studied. Methods and Results-We used intravascular ultrasound to determine the incidence, morphology. and clinical features of post-PCI intramural hematomas. In 905 patients With 1025 consecutive native coronary artery, non-in-stent restenosis lesions undergoing PCI, 72 hematomas were detected in 69 arteries in 68 patients. The incidence of intramural hematomas per artery was 6.7% (69 of 1025); 36% (26 of 72) involved the proximal reference artery, 18% (13 of 72) were confined to the lesion, and 46% (33 of 72) involved the distal reference artery. The entry site from the lumen into the hematoma was identified in 86% of hematomas (62 of 72) and had the appearance of a dissection into the media. Conversely, a re-entry site was identifiable in only 8% (6 of 72). The axial extension of the hematoma was distal. in 63% and proximal in 37%. In 60% of the hematomas (42 of 72) the angiogram had the appearance of a dissections in 11% (8 of 72), it appeared to be a new stenosis: and in 29% (22 of 72), no significant abnormality Was detected. Non-Q-wave myocardial infarctions occurred in 26% of patients (17 of 65). In 3 patients, the creatine kinase-MB was not measured during the hospital stay. Repeat revascularization occur-red in 2 patients in-hospital. 2 additional patients at I month, and 8 additional patients at I year. There were 3 sudden deaths at I year. Conclusions-Intravascular ultrasound identified intramural hematomas after 6.7% of PCIs. The mechanism appeared to be a dissection into the media where blood accumulated because of a lack of re-entry. A third of ultrasound-identified hematomas showed no angiographic abnormalities. There was a high rate of non-Q-wave myocardial infarction, need for repeat revascularization, and sudden death in patients with hematomas.