Coronary artery hematoma in a case of chronic total occlusion treated with intravascular imaging and a novel scoring balloon catheter

A 69-year-old female with stable angina pectoris underwent percutaneous coronary intervention for a chronic total occlusion (CTO) in the left anterior descending coronary artery (LAD). A semi-compliant balloon catheter (BC) ruptured in the CTO lesion, causing a hematoma due to coronary artery dissection in the distal LAD. A new scoring BC; NSE Alpha (Goodman, Aichi, Japan) was selected for use after intravascular imaging. The NSE Alpha contains 3 triangular nylon elements along the outside of the balloon. The hematoma was treated prior to successful implantation of a drug-eluting stent. Coronary artery hematoma as a complication in percutaneous coronary intervention is rare but is sometimes associated with coronary artery obstruction which may result in further complications such as acute myocardial infarction. Cutting balloon angioplasty using intravascular imaging is a useful treatment strategy to resolve a hematoma. However, the cutting balloon catheter is associated with poor deliverability to locations such as distal to the left anterior descending coronary artery. For these types of cases, a new scoring balloon catheter has shown to be efficacious and safe in resolving coronary artery hematomas.