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Compressive Coronary Hematoma in an Elderly Woman Receiving Oral Anticoagulation Treated With Cutting Balloon Fenestration

Year: 2026

Type: article

Abstract: BACKGROUND: Intramural hematoma (IMH) is an uncommon cause of acute coronary syndrome and may occur in elderly patients with vascular fragility receiving oral anticoagulation. CASE SUMMARY: ). OCT-guided cutting balloon fenestration in the posterolateral branch (3 inflations, 16 bar) restored TIMI flow grade 3 without stenting. On day 3, complete atrioventricular block with pauses of >7 seconds led to permanent pacemaker implantation. Systematic angiography on day 5 showed silent distal right coronary artery IMH extension, prompting anticoagulation discontinuation. At 3 months, complete healing was observed, followed by left atrial appendage closure. No events occurred during the 4-year follow-up. DISCUSSION: Selective OCT-guided fenestration enabled durable revascularization without stent implantation. TAKE-HOME MESSAGE: Cutting balloon fenestration provides favorable long-term outcomes in compressive IMH.

Source: JACC Case Reports

DOI: 10.1016/j.jaccas.2026.107262

Authors: Kais Ouerghi, Victor Mateus, Tahar Lazizi, Loïc Bière

Institution: Centre Hospitalier Universitaire d'Angers

Language: English

Topic: Coronary Interventions and Diagnostics

Subfield: Surgery

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $850