Incidence, morphology, angiographic findings, and outcomes of intramural hematomas after percutaneous coronary interventions

An intravascular ultrasound study

Akiko Maehara, Gary S. Mintz, Anh B. Bui, Marco T. Castagna, Olga R. Walter, Chrysoula Pappas, Ellen E. Pinnow, Augusto D. Pichard, Lowell F. Satler, Ron Waksman, William O. Suddath, John R. Laird, Kenneth M. Kent, Neil J. Weissman

Research output: Contribution to journalArticle

62 Citations (Scopus)

Abstract

Background - Intramural hematomas during percutaneous coronary intervention (PCI) have not been well studied. Methods and 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.

Original languageEnglish (US)
Pages (from-to)2037-2042
Number of pages6
JournalCirculation
Volume105
Issue number17
DOIs
StatePublished - Apr 30 2002
Externally publishedYes

Fingerprint

Percutaneous Coronary Intervention
Hematoma
Incidence
Arteries
Dissection
Sudden Death
Myocardial Infarction
MB Form Creatine Kinase
Stents
Length of Stay
Coronary Vessels
Angiography
Pathologic Constriction

Keywords

  • Circulation
  • Hematoma
  • Ultrasonics

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

Incidence, morphology, angiographic findings, and outcomes of intramural hematomas after percutaneous coronary interventions : An intravascular ultrasound study. / Maehara, Akiko; Mintz, Gary S.; Bui, Anh B.; Castagna, Marco T.; Walter, Olga R.; Pappas, Chrysoula; Pinnow, Ellen E.; Pichard, Augusto D.; Satler, Lowell F.; Waksman, Ron; Suddath, William O.; Laird, John R.; Kent, Kenneth M.; Weissman, Neil J.

In: Circulation, Vol. 105, No. 17, 30.04.2002, p. 2037-2042.

Research output: Contribution to journalArticle

Maehara, A, Mintz, GS, Bui, AB, Castagna, MT, Walter, OR, Pappas, C, Pinnow, EE, Pichard, AD, Satler, LF, Waksman, R, Suddath, WO, Laird, JR, Kent, KM & Weissman, NJ 2002, 'Incidence, morphology, angiographic findings, and outcomes of intramural hematomas after percutaneous coronary interventions: An intravascular ultrasound study', Circulation, vol. 105, no. 17, pp. 2037-2042. https://doi.org/10.1161/01.CIR.0000015503.04751.BD
Maehara, Akiko ; Mintz, Gary S. ; Bui, Anh B. ; Castagna, Marco T. ; Walter, Olga R. ; Pappas, Chrysoula ; Pinnow, Ellen E. ; Pichard, Augusto D. ; Satler, Lowell F. ; Waksman, Ron ; Suddath, William O. ; Laird, John R. ; Kent, Kenneth M. ; Weissman, Neil J. / Incidence, morphology, angiographic findings, and outcomes of intramural hematomas after percutaneous coronary interventions : An intravascular ultrasound study. In: Circulation. 2002 ; Vol. 105, No. 17. pp. 2037-2042.
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abstract = "Background - Intramural hematomas during percutaneous coronary intervention (PCI) have not been well studied. Methods and 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.",
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T1 - Incidence, morphology, angiographic findings, and outcomes of intramural hematomas after percutaneous coronary interventions

T2 - An intravascular ultrasound study

AU - Maehara, Akiko

AU - Mintz, Gary S.

AU - Bui, Anh B.

AU - Castagna, Marco T.

AU - Walter, Olga R.

AU - Pappas, Chrysoula

AU - Pinnow, Ellen E.

AU - Pichard, Augusto D.

AU - Satler, Lowell F.

AU - Waksman, Ron

AU - Suddath, William O.

AU - Laird, John R.

AU - Kent, Kenneth M.

AU - Weissman, Neil J.

PY - 2002/4/30

Y1 - 2002/4/30

N2 - Background - Intramural hematomas during percutaneous coronary intervention (PCI) have not been well studied. Methods and 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.

AB - Background - Intramural hematomas during percutaneous coronary intervention (PCI) have not been well studied. Methods and 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.

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KW - Hematoma

KW - Ultrasonics

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