The “Cuttering (Cutting-Dottering Balloon) Technique” for treatment of flow-limiting coronary intramural hematoma

Background

Coronary artery dissections are caused by a tear in the vessel endothelium, resulting in blood extravasation into the subintimal space, with subsequent intramural hematoma (IMH). One potential technique to deal with this complication is the use of cutting balloons, however, a significant number of cases experienced distal propagation of the hematoma. We describe a novel technique that enhances the possibility of creating intimal tears between the false and true lumen, aiding in hematoma drainage and restoring distal coronary flow.

Methods

We conducted a retrospective analysis of seven consecutive patients who underwent percutaneous coronary intervention complicated by flow-limiting intramural hematomas. All patients were treated using the “Cuttering Technique,” based on the operators’ preference. Procedural success was defined as achieving a distal thrombolysis in myocardial infarction 3 (TIMI 3) flow.

Results

In five out of seven patients treated with “Cuttering Technique” we observed a complete restoration of TIMI 3 flow into the dissected segment.

Conclusions

Our cases show the effectiveness of the “Cuttering Technique” as a viable approach for managing IMHs. This technique enhances the possibility of creating intimal tears between the false and true lumens, aiding in hematoma drainage and restoring distal coronary flow.