Author + information
- Thomas W. Johnson, BSc, MBBS, MD⁎ (, )
- David Smith, BSc, MBBS,
- Julian W. Strange, MBChB, MD,
- Chiara Bucciarelli-Ducci, MD, PhD,
- Robert Lowe, MBChB, MD and
- Andreas Baumbach, MD
- ↵⁎Bristol Heart Institute, Upper Maudlin Street, Bristol BS2 8HW, United Kingdom
Spontaneous coronary arterial intramural hematoma is a rarely diagnosed cause of acute myocardial infarction. The underlying pathophysiology is poorly understood. A historical series of intramedial dissecting hematomas, published in 1965 (1), postulated that rupture of the vasa vasorum or cystic medial necrosis, as described in the aorta by Erdheim (2), could be the precipitant. The appearance of angiographic luminal obstruction, without intravascular imaging to investigate its etiology, is likely to have contributed to an under-reporting of this phenomenon. A small number of case reports document intramural hematoma by intravascular ultrasound; however, the limited resolution of intravascular ultrasound may preclude accurate delineation of the associated arterial deformation and underlying pathological processes (3,4). Optical coherence tomography provides superior resolution on the order of 10 to 15 μm and may allow better characterization of intramural abnormalities, assessment of vessel integrity, and exclusion of atheroma.
Here, we present a case of intramural coronary hematoma in a patient presenting with ST-segment elevation myocardial infarction where the use of optical coherence tomography allowed us to clearly define the underlying cause of luminal obstruction (Fig. 1,Online Videos 1, 2, 3, and 4). Our report suggests that important information can be gleaned from use of optical coherence tomography in addition to angiography, which in some cases may alter medical management.
For supplementary videos and their legends, please see the online version of this article.
- American College of Cardiology Foundation
- Nalbandian R.M.,
- Chason J.L.
- Fujikura H.,
- Hata Y.,
- Morino Y.,
- et al.