coronary intramural hematoma

IVUS description of coronary intramural hematoma that occurred after balloon dilatation

[@mariwankhorani9619]

Well done dr Amjad very nice demonstration and teaching video God bless you 👏👏👏💐💐💐

[@hassanessai6733]

Thanks a lot dr.Amjad for presenting this not uncommon complication during PCI and how to deal with it in the moment.

[@42much1]

Excellent presentation and very good teaching points. The art of angioplasty, which comes from years of practice but also interpretation, is that fine tuning that allows you to find the balance between diameters and pressure applied to balloons and stents. But even the most experienced operators are sometimes caught off guard by unexpected events.

[@fatherabdul]

Excellent Thank you

[@varicruse]

Thank you very much for excellent demonstration can you anticipate such complications weather related to calcification, ectasia, balloon to vessel ratio etc. Thank you again for these interesting series

[@amjadalmendilawi5328]

It’s difficult to predict that , but we found it more in focal lesions compared to more diffuse one . It’s said that a hard lesion can resist balloon inflation and so higher pressure may disrupt the intima into the media at the less resistant part of the artery

[@mohammednaseer991]

Nice presentation thank you sir

[@drmaqboolsohail1960]

I think it was localised SCAD with localised Intramural Hematoma. Because IVUS Pull back shows minimal Atherosclerosis and plaque burden

[@mustaphaabdallah4886]

Nice work 😁

[@hasanmohammed276]

Well done Dr Amjed It is an amazing demonstration, in case of absence of IVUS , do you think that would make a difference??? provided that stenting would be done ultimately.

[@amjadalmendilawi5328]

Agree with you that stenting is required anyway in this case , but the IVUS gave an insight into the pathology. In other cases when the distal vessel is small or when you get a total occlusion , we need to understand the pathology

[@laithfalah4720]

عاشت ايدك استاذ

[@MohammedHassan-xi4fq]

Thanks thanks

[@tahsinalkinani880]

👍🏼👍🏼👍🏼 I have two questions 1: Was it possible to see by IVUS the site of dissection and entry into the vessel wall? 2: if you had a cutting balloon, would you have used it to decompress the hematoma distally and avoid a long stent?

[@amjadalmendilawi5328]

1- If you review the IVUS you can see an area of intimal flap just distal to the proximal branch , it’s circumferential, so difficult to tell about the entry , but it’s there where everything started and progressed both proximally and distally . 2- theoretically cutting balloon might have been useful, but I wouldn’t have risked inflation at the distal joint in this large artery.

[@NikhilJha89]

Hematoma should be between intima and media not outside media

[@holmes0087]

Sir one hypothetical question... What to do if IVUS not available, how to proceed...

[@drgaganvelayudhan1733]

Would want to assess the approx length of the hematoma angiographically and place the longest Stent available to cover it.