A Bleeding Kiss: intramural haematoma secondary to balloon angioplasty

BACKGROUND: Intramural coronary haematoma following percutaneous coronary intervention in the absence of coronary dissection is a rare phenomenon. CASE PRESENTATION: A 69 year old lady with previous prosthetic aortic valve replacement underwent percutaneous coronary intervention (PCI) from the left mainstem to the left anterior descending artery (LAD) and kissing balloon inflations to the LAD and circumflex (Cx) arteries. Although intravascular ultrasound examination (IVUS) of both the LAD and Cx showed both vessels to be widely patent at the end of the procedure, she developed ischaemic chest pain six hours later. Repeat coronary angiography revealed a significant stenosis in the proximal Cx vessel, which was confirmed on IVUS to be intramural haematoma. CONCLUSION: In patients taking warfarin in addition to standard antiplatelet therapy, kissing balloon inflations should be carried out with caution.