title: A bleeding kiss: intramural haematoma secondary to balloon angioplasty.
abstract: BACKGROUND
  Intramural coronary haematoma following percutaneous coronary intervention in the absence of coronary dissection is a rare phenomenon.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  In patients taking warfarin in addition to standard antiplatelet therapy, kissing balloon inflations should be carried out with caution.
authors.affiliation: Department of Cardiology, John Radcliffe Hospital, Oxford, UK. cshirodaria@doctors.org.uk
authors.forename: Cheerag
authors.initials: C
authors.lastname: Shirodaria
authors.forename: William J
authors.initials: WJ
authors.lastname: Van Gaal
authors.forename: Adrian P
authors.initials: AP
authors.lastname: Banning
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000209:etiology* / Q000628:therapy; D005260:Female; D006406:Hematoma / Q000000981:diagnostic imaging* / Q000209:etiology* / Q000628:therapy; D006801:Humans; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional / Q000379:methods