Fenestration using a scoring balloon Scoreflex® as troubleshooting for acute vessel closure due to intramural hematoma complication in percutaneous coronary intervention

Abstract

This case report demonstrated the usefulness of scoring balloon when luminal narrowing occurred after balloon angioplasty in the left circumflex artery due to coronary intramural hematoma. Although a stent was placed, coronary flow was not improved. We intended to make a fenestra between the true lumen and the hematoma using a scoring balloon (Scoreflex® 2.0 × 10 mm, OrbusNeich, Tokyo, Japan) which was dilated in the distal segment of the branch. Angiograms showed restoration of TIMI-3 flow with a long dissection spanning from distal of the stent to the scored area. After 3 months and 1 year, follow-up coronary angiograms demonstrated occluded false lumen and good coronary flow in the treated vessel.

Imaging behind occluded areas with an iatrogenic perforated balloon: A safe, practical, and simple new method of visualizing the distal lumen in total occlusion

“…Most of the time, decisions regarding balloon dilatation of the lesion are based on the discretion of the operator. This condition may sometimes cause vascular dissection, rupture, or ballooning of the false lumen …”

Coronary Artery Hematoma Treated with Fenestration Using a Novel NSE Alpha® Scoring Balloon

“…However, there are some concerns that stenting may cause longitudinal hematoma extension and is associated with an increased rate of restenosis and stent thrombosis [ 3 , 5 ]. Some studies have reported good results for fenestration using cutting balloons [ 6 ], scoring balloons [ 7 ], and stiff guidewires [ 8 ]. Creating a fenestration between the true lumen and the hematoma leads to a reduction in pressure in the intramural hematoma.…”

Spontaneous coronary artery dissection: contemporary aspects of diagnosis and patient management

“…The use of a cutting or scoring balloon to fenestrate the intimomedial flap in order to decompress intramural haematomas is an interesting concept, though not free of risk. A few isolated published cases have reported a favourable outcome93 94; however, this kind of evidence is susceptible to selection and/or publication bias.…”