title: Incidence, morphology, angiographic findings, and outcomes of intramural hematomas after percutaneous coronary interventions: an intravascular ultrasound study.
abstract: BACKGROUND
  Intramural hematomas during percutaneous coronary intervention (PCI) have not been well studied.
  
  
  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 dissection; 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 occurred in 2 patients in-hospital, 2 additional patients at 1 month, and 8 additional patients at 1 year. There were 3 sudden deaths at 1 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.
authors: Intravascular Ultrasound Imaging and Cardiac Catheterization Laboratories, Cardiovascular Research Institute, Washington Hospital Center, Washington, DC 20010, USA.
authors: Akiko
authors: A
authors: Maehara
authors: Gary S
authors: GS
authors: Mintz
authors: Anh B
authors: AB
authors: Bui
authors: Marco T
authors: MT
authors: Castagna
authors: Olga R
authors: OR
authors: Walter
authors: Chrysoula
authors: C
authors: Pappas
authors: Ellen E
authors: EE
authors: Pinnow
authors: Augusto D
authors: AD
authors: Pichard
authors: Lowell F
authors: LF
authors: Satler
authors: Ron
authors: R
authors: Waksman
authors: William O
authors: WO
authors: Suddath
authors: John R
authors: JR
authors: Laird
authors: Kenneth M
authors: KM
authors: Kent
authors: Neil J
authors: NJ
authors: Weissman
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects*; D017023:Coronary Angiography; D003327:Coronary Disease / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000209:etiology*; D023903:Coronary Restenosis / Q000628:therapy; D003331:Coronary Vessels / Q000000981:diagnostic imaging; D005260:Female; D006406:Hematoma / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D015994:Incidence; D008297:Male; D016896:Treatment Outcome; D014463:Ultrasonography