Intramyocardial Hematoma After Percutaneous Coronary Intervention for Chronic Total Occlusion: Two Case Reports

Percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) is an extremely challenging procedure, with intramyocardial hematoma (IMH) being one of its rare yet severe complications. In this report, we detail two cases of IMH occurring during PCI for CTO, emphasizing the importance of avoiding catheter pressure entrapment and high - dose antegrade angiography during recanalization. Both cases were the right coronary artery (RCA) CTO. In one case, after antegrade recanalization, the patient developed pericardial tamponade secondary to IMH due to these risky factors (catheter pressure entrapment and high-dose antegrade angiography), which necessitated surgical intervention. In the other case, following the same risky factors and repeated angiography, the patient experienced hypotension due to IMH, diagnosed by transthoracic echocardiography. However, as the hematoma did not involve the pericardium, conservative management was adopted.