Spontaneous Multivessel Coronary Intramural Hematoma: An Insight With OCT
Spontaneous coronary arterial intramural hematoma is a rarely diagnosed cause of acute myocardial infarction. The underlying pathophysiology is poorly understood. A historical series of intramedial dissecting hematomas, published in 1965 ( 1 ), postulated that rupture of the vasa vasorum or cystic medial necrosis, as described in the aorta by Erdheim ( 2 ), could be the precipitant. The appearance of angiographic luminal obstruction, without intravascular imaging to investigate its etiology, is likely to have contributed to an under-reporting of this phenomenon. A small number of case reports document intramural hematoma by intravascular ultrasound; however, the limited resolution of intravascular ultrasound may preclude accurate ...
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