Author + information
- Received March 28, 2010
- Revision received June 25, 2010
- Accepted July 10, 2010
- Published online November 1, 2010.
- Chiara Fraccaro, MD,
- Giambattista Isabella, MD and
- Giuseppe Tarantini, MD, PhD⁎ ()
- ↵⁎Reprint requests and correspondence:
Dr. Giuseppe Tarantini, Department of Cardiac, Thoracic, and Vascular Sciences, University of Padua, Giustiniani 1, Padua 35128, Italy
A 67-year-old obese woman with a history of hypertension and dyslipidemia was admitted at our institution because of non–ST-segment elevation myocardial infarction. Electrocardiography at admission showed flat T waves in inferiorlateral leads. Two-dimensional transthoracic echocardiography revealed infero-lateral wall hypokinesia. Troponin I peaked at 18 μg/l. Coronary angiography showed patent coronary arteries without significant stenoses and with Thrombolysis In Myocardial Infarction (TIMI) flow grade 3. Indeed, an intermediate tubular lesion with smooth shape and endoluminal haziness was present at distal left circumflex artery (LCX) (segment A marked in yellow in Fig 1). There was no lumen thrombosis, but contrast density along the course of LCX was inhomogeneous. At intravascular ultrasound (Volcano Therapeutics, Rancho Cordova, California) evaluation, a crescent-shaped lesion (false lumen) through the LCX was visible (Figs. 1A to 1E), lined by the internal elastic membrane (white arrows in Fig. 1). Moreover, an echogenic mass was evident within the vessel wall (intramural hematoma).
No atherosclerotic lesions were visible. The backscatter intensity of blood increased from the proximal to the distal part of the crescent-shaped area, as a consequence of partial thrombosis of the false lumen.
The other coronaries appeared normal. The patient was discharged 1 week later with dual antiplatelet therapy and remained asymptomatic at 1-year follow-up.
Intramural hematoma after spontaneous dissection is not exceptional and should always be suspected and confirmed by intravascular ultrasound in case of acute coronary syndrome without overt severe coronary lesions at angiography. The presence of intermediate, tubular coronary lesions with smooth shape or the evidence of abrupt loss of the vessel size, in the absence of thrombosis or intimal flail, should be suspected for intramural hematoma (1,2). Of note, when the patient is clinically stable with TIMI flow grade 3, percutaneous treatment is not mandatory because of the risk of hematoma progression and the likelihood of spontaneous healing (3).
The authors have reported that they have no relationships to disclose.
- Received March 28, 2010.
- Revision received June 25, 2010.
- Accepted July 10, 2010.
- American College of Cardiology Foundation
- Mintz G.S.,
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