EXTENSIVE INTRAMURAL HEMATOMA AS THE CAUSE OF FAILED CORONARY ANGIOPLASTY - DIAGNOSIS BY INTRAVASCULAR ULTRASOUND AND TREATMENT BY STENT IMPLANTATION

Dissections after coronary angioplasty are the major cause of ischemic events following percutaneous transluminal coronary angioplasty (PTCA ) and may require additional measures such as intravascular stent depl oyment to relieve or prevent acute vessel closure. We describe a rare type of dissection after PTCA which caused a severe obstruction of the vessel segment proximal to the dilatation site without a visible diss ection flap. Intravascular ultrasound was used to elucidate the morpho logy of the proximal vessel obstruction, which revealed an intramural hematoma extending into the proximal vessel segment as underlying mech anism. A Palmaz-Schatz stent was placed at the entry site of this hema toma, which led to the relief of the proximal vessel obstruction. Afte r 3 months of anticoagulation therapy the repeat coronary angiography showed no significant restenosis. This demonstrates the unique insight into the underlying morphology of failed PTCA by intravascular ultras ound, which can help to manage even rare and unusual complications. (C ) 1995 Wiley-Liss, Inc.