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A PICTURE IS WORTH A THOUSAND WORDS
Year : 2019  |  Volume : 20  |  Issue : 1  |  Page : 32-33  

Optical coherence tomography and intravascular ultrasound in diagnosis of coronary intramural hematoma


Department of Cardiology, Madras Medical Mission, Chennai, Tamil Nadu, India

Date of Web Publication7-May-2019

Correspondence Address:
Dr. Deep Chandh Raja
Department of Cardiology, Institute of Cardio-vascular Disease, Madras Medical Mission, 4-A, Dr. J. Jayalalitha Nagar, Mogappair, Chennai - 600 037, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/HEARTVIEWS.HEARTVIEWS_97_17

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How to cite this article:
Raja DC, Subban V, Livingston N, Thenpally J, Mullasari AS. Optical coherence tomography and intravascular ultrasound in diagnosis of coronary intramural hematoma. Heart Views 2019;20:32-3

How to cite this URL:
Raja DC, Subban V, Livingston N, Thenpally J, Mullasari AS. Optical coherence tomography and intravascular ultrasound in diagnosis of coronary intramural hematoma. Heart Views [serial online] 2019 [cited 2019 Jun 18];20:32-3. Available from: http://www.heartviews.org/text.asp?2019/20/1/32/257795



Intramural hematoma (IMH) tends to occur in a fibrous plaque secondary to balloon dilatation or stent implantation. They are one of the important causes of unexplained deterioration in coronary flows during percutaneous coronary interventions. These IMHs are barely visible on routine coronary angiograms. In an optical coherence tomography (OCT) image, they give rise to a double-lumen appearance with a glistening intimomedial membrane separating the false and the true lumen [Figure 1].
Figure 1: Optical coherence tomography appearance of intramural hematomas. Panel A shows the longitudinal layout with cross-section images at three levels (i, ii, and iii). A biovascular scaffold was used. A-ii (*)-intimal flap. A-iii (*)-crescent shaped intramural hematoma, and A-iii (arrow)-intimomedial membrane. Panel B 3D optical coherence tomography T-reconstruction, arrow-the entry site of intramural hematomas, *-extent of intramural hematoma. Panel C cross-section optical coherence tomography image, *-exit site. Panel D arrow-intimomedial membrane, *-hematoma

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OCT may not reveal the extramural extent of IMH, which is better visualized in intravascular ultrasound (IVUS), where the IMH appears as an echogenic crescent-shaped blood collection in the extravascular space between the internal and external elastic membrane [Figure 2].
Figure 2: Intravascular ultrasound appearance of intramural hematomas. Panel A double-headed arrow-the longitudinal extent of the intramural hematoma along with cross-section images at four levels from proximal to distal (i, ii, iii, and iv) A-ii (*)-intramural hematoma, A-iii to iv (arrow)-extramural extent. Panel B *-intramural hematoma. Panel C arrow-shows the angiographic “neo-stenosis” observedjust distal the stent-edge after its deployment. Panel D *-echogenic crescent-shaped blood collection, arrow-external elastic membrane

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In addition to the extent of the IMH, the entry and exit sites can be studied with IVUS as well as OCT. Such IMHs need to be addressed with stents of sufficient length to cover the entire extent of the IMH.[1]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Maehara A, Mintz GS, Bui AB, Castagna MT, Walter OR, Pappas C, et al. Incidence, morphology, angiographic findings, and outcomes of intramural hematomas after percutaneous coronary interventions: An intravascular ultrasound study. Circulation 2002;105:2037-42.  Back to cited text no. 1
    


    Figures

  [Figure 1], [Figure 2]



 

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