Incidence, morphology, angiographic findings, and outcomes of intramural hematomas after percutaneous coronary interventions: an intravascular ultrasound study

Circulation. 2002 Apr 30;105(17):2037-42. doi: 10.1161/


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.

Publication types

  • Clinical Trial

MeSH terms

  • Angioplasty, Balloon, Coronary / adverse effects*
  • Coronary Angiography
  • Coronary Disease / diagnostic imaging*
  • Coronary Disease / epidemiology
  • Coronary Disease / etiology*
  • Coronary Restenosis / therapy
  • Coronary Vessels / diagnostic imaging
  • Female
  • Hematoma / diagnostic imaging*
  • Hematoma / epidemiology
  • Hematoma / etiology*
  • Humans
  • Incidence
  • Male
  • Treatment Outcome
  • Ultrasonography