Acute Coronary Syndrome due to Intramural Hematoma
2006; Lippincott Williams & Wilkins; Volume: 114; Issue: 25 Linguagem: Inglês
10.1161/circulationaha.106.629162
ISSN1524-4539
AutoresHisanori Fujikura, Yoshiki Hata, Yoshihiro Morino, A Matsuzaki, Keiko Oikawa, Yuji Ikari, Junichi Taguchi,
Tópico(s)Infective Endocarditis Diagnosis and Management
ResumoHomeCirculationVol. 114, No. 25Acute Coronary Syndrome due to Intramural Hematoma Free AccessReview ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessReview ArticlePDF/EPUBAcute Coronary Syndrome due to Intramural Hematoma Hisanori Fujikura, MD, Yoshiki Hata, MD, Yoshihiro Morino, MD, Atsushi Matsuzaki, MD, Keiko Oikawa, MD, Yuji Ikari, MD and Junichi Taguchi, MD Hisanori FujikuraHisanori Fujikura From the Fujikura Clinic, Yokohama (H.F.), Tokai University, Hachioji Hospital, Hachioji (Y.H., K.O.), Department of Cardiology, Tokai University School of Medicine, Isehara (Y.M., A.M., Y.I.), and Tokyo Midtown Medicine, Tokyo (J.T.), Japan. , Yoshiki HataYoshiki Hata From the Fujikura Clinic, Yokohama (H.F.), Tokai University, Hachioji Hospital, Hachioji (Y.H., K.O.), Department of Cardiology, Tokai University School of Medicine, Isehara (Y.M., A.M., Y.I.), and Tokyo Midtown Medicine, Tokyo (J.T.), Japan. , Yoshihiro MorinoYoshihiro Morino From the Fujikura Clinic, Yokohama (H.F.), Tokai University, Hachioji Hospital, Hachioji (Y.H., K.O.), Department of Cardiology, Tokai University School of Medicine, Isehara (Y.M., A.M., Y.I.), and Tokyo Midtown Medicine, Tokyo (J.T.), Japan. , Atsushi MatsuzakiAtsushi Matsuzaki From the Fujikura Clinic, Yokohama (H.F.), Tokai University, Hachioji Hospital, Hachioji (Y.H., K.O.), Department of Cardiology, Tokai University School of Medicine, Isehara (Y.M., A.M., Y.I.), and Tokyo Midtown Medicine, Tokyo (J.T.), Japan. , Keiko OikawaKeiko Oikawa From the Fujikura Clinic, Yokohama (H.F.), Tokai University, Hachioji Hospital, Hachioji (Y.H., K.O.), Department of Cardiology, Tokai University School of Medicine, Isehara (Y.M., A.M., Y.I.), and Tokyo Midtown Medicine, Tokyo (J.T.), Japan. , Yuji IkariYuji Ikari From the Fujikura Clinic, Yokohama (H.F.), Tokai University, Hachioji Hospital, Hachioji (Y.H., K.O.), Department of Cardiology, Tokai University School of Medicine, Isehara (Y.M., A.M., Y.I.), and Tokyo Midtown Medicine, Tokyo (J.T.), Japan. and Junichi TaguchiJunichi Taguchi From the Fujikura Clinic, Yokohama (H.F.), Tokai University, Hachioji Hospital, Hachioji (Y.H., K.O.), Department of Cardiology, Tokai University School of Medicine, Isehara (Y.M., A.M., Y.I.), and Tokyo Midtown Medicine, Tokyo (J.T.), Japan. Originally published19 Dec 2006https://doi.org/10.1161/CIRCULATIONAHA.106.629162Circulation. 2006;114:e644–e645A 43-year-old female who had 3 healthy children (12, 10, and 6 years old) was admitted to the emergency room with chest oppression. An ECG revealed elevated ST-segments in leads V2 to V6. Emergency coronary angiography was performed, and a severe stenosis was observed in the left anterior descending artery. Intravascular ultrasound was performed after the angiography. Interestingly, intravascular ultrasound findings demonstrated that the angiographic stenosis was attributable to an intramural hematoma of the proximal left anterior descending artery, extending to left main coronary artery (Figure 1). Furthermore, the vessel wall around the hematoma segments seemed to be less atherosclerotic and nearly healthy in structure. Because both ischemic symptoms and signs completely disappeared during catheterization, we decided not to perform any additional interventional treatments for this patient. Download figureDownload PowerPointFigure 1. Coronary angiogram and representative cross-sections of grayscale intravascular ultrasound. A severe eccentric stenosis was observed in the proximal left anterior descending artery. A huge intramural hematoma (*) was demonstrated at the angiographic stenosis segment, and it extended to the more proximal left anterior descending artery and left main artery. No apparent entry was noted throughout these segments. A, left main artery; B, proximal portion of lad; and C, lesion of minimum luminal area.Thirty-five days after admission, coronary angiogram and intravascular ultrasound were reperformed to assess serial changes of this coronary lesion. Surprisingly, the intramural hematoma had completely healed, and it presented normally on both angiogram and intravascular ultrasound (Figure 2). The huge coronary hematoma seen on admission (Figure 1) had healed entirely and naturally within 5 weeks. Download figureDownload PowerPointFigure 2. Huge hematoma observed in Figure 1 completely healed at 1-month follow-up in both angiogram and corresponding grayscale intravascular ultrasound images. The vascular wall appeared nearly normal throughout the formerly dissected coronary segment.A spontaneous intramural hematoma/dissection is one of the possible causes of acute coronary syndrome. Several factors such as the pre- and postpartum periods, trauma, hypertension, vasculitis, and the use of contraceptives or illicit medications may potentially relate to this phenomenon, yet this patient did not possess any of them. Importantly, a hematoma's healing process is absorption of the hemorrhage, which is quite different from those of plaque rupture or erosion.DisclosuresNone.FootnotesCorrespondence to Hisanori Fujikura, MD, Fujikura Clinic, 2–14–7, Utsukushigaoka, Aobaku, Yokohama, Kanagawa, 225–0002, Japan. E-mail [email protected] Previous Back to top Next FiguresReferencesRelatedDetailsCited By Lécuyer A, Castellant P, Le Ven F, Didier R, Nicol P, David C, Mansourati J and Gilard M (2016) Giant aneurysmal evolution of a spontaneous coronary artery dissection in the postpartum, International Journal of Cardiology, 10.1016/j.ijcard.2015.08.147, 202, (362-365), Online publication date: 1-Jan-2016. Shenoda M and Aragon J (2015) Coronary intramural hematomas: a focused review, Interventional Cardiology, 10.2217/ica.15.15, 7:3, (239-243), Online publication date: 1-Jul-2015. Antonsen L, Thayssen P and Jensen L (2015) Large coronary intramural hematomas: a case series and focused literature review, Cardiovascular Revascularization Medicine, 10.1016/j.carrev.2014.10.009, 16:2, (116-123), Online publication date: 1-Mar-2015. Giacoppo D, Capodanno D, Dangas G and Tamburino C (2014) Spontaneous coronary artery dissection, International Journal of Cardiology, 10.1016/j.ijcard.2014.04.178, 175:1, (8-20), Online publication date: 1-Jul-2014. Badr S, Dvir D, Pichard A and Waksman R (2013) Acute closure after stenting, Catheterization and Cardiovascular Interventions, 10.1002/ccd.24780, 82:5, (765-767), Online publication date: 1-Nov-2013. Lanzer P (2013) Intracoronary Stenting Strategies Catheter-Based Cardiovascular Interventions, 10.1007/978-3-642-27676-7_29, (497-529), . Ducas R, Jassal D and Hussain F (2018) A Case of Circumferential Multi-Vessel Coronary Intramural Hematoma in a Post-Menopausal Woman, Heart International, 10.4081/hi.2011.e10, 6:2, (hi.2011.e10), Online publication date: 1-Jan-2011. Walsh S, Jokhi P and Saw J (2009) Successful percutaneous management of coronary dissection and extensive intramural haematoma associated with ST elevation MI, Acute Cardiac Care, 10.1080/17482940701802348, 10:4, (231-233), Online publication date: 1-Jan-2008. December 19, 2006Vol 114, Issue 25 Advertisement Article InformationMetrics https://doi.org/10.1161/CIRCULATIONAHA.106.629162PMID: 17179027 Originally publishedDecember 19, 2006 PDF download Advertisement SubjectsImaging
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