Interventional Management of Intracoronary Dissection/Hematoma: A Comprehensive Review

Intracoronary dissection and hematoma are rare but significant causes of acute coronary syndromes (ACS), often leading to myocardial ischemia and infarction. Given their heterogeneous clinical presentation and the limited evidence on optimal management strategies, this review aims to evaluate current treatment approaches, including conservative, percutaneous, and surgical options, while highlighting emerging innovations and future research directions.

Recent studies emphasize the role of advanced intracoronary imaging techniques, such as optical coherence tomography (OCT) and intravascular ultrasound (IVUS), in improving diagnostic accuracy and guiding therapeutic decisions. Conservative management is increasingly recognized as a viable option for stable patients, offering favorable long-term outcomes. Percutaneous coronary intervention (PCI) is indicated in cases with ongoing ischemia, hemodynamic instability, or high-risk anatomical features, though it carries risks such as dissection propagation and coronary rupture. Surgical intervention remains essential in cases of failed PCI or left main stem involvement, demonstrating high survival rates despite procedural challenges.

Tailored therapeutic strategies, informed by patient-specific factors and intracoronary imaging, are crucial for optimizing outcomes in intracoronary dissection and hematoma. While conservative management is effective in selected cases, PCI and surgical interventions remain vital for high-risk patients. Future research should focus on refining risk stratification tools, improving imaging modalities, and developing standardized treatment algorithms to enhance patient care and clinical outcomes.