Coronary artery intramural hematoma, a rare complication of percutaneous coronary intervention

Coronary artery intramural hematoma is a rare complication of percutaneous coronary intervention which develops from intimal tear of coronary artery and propagates by blood accumulation along the medial surface of adjacent segment. Fifty-three-year-old male presented with nonexertional chest pain; he was referred after a positive stress test with+ moderate lateral wall ischemia. Coronary angiography showed 80% lesion in mid-left anterior descending artery (mLAD). Angiogram after angioplasty with 2.0 mm × 15 mm balloon and 3.0 mm × 15 mm drug-eluting-stent demonstrated a new stenotic lesion distal to stented mLAD segment. Subsequently, an overlapping 3.0 mm × 30 mm stent was placed with effective restoration of blood flow through LAD. During percutaneous coronary intervention (PCI), balloon predilatation can result in plaque fracture and stent deployment may cause intimal tear forming intramural hematoma which can lead to post-PCI myocardial infarction necessitating prompt detection by intravascular imaging with intravascular ultrasound and optical coherence tomography. Management is based on individual patient's characteristics and includes medical therapy, angiographic surveillance or repeat PCI.