Successful angioplasty with intravascular ultrasound and optical frequency domain imaging guidance for tandem intramural hematoma caused by coronary artery spasm.

A 39-year-old woman with no coronary risk factors was admitted due to repetitive morning chest pain. Coronary angiography revealed subtotal occlusion of the distal obtuse marginal branch that was not recanalized by intracoronary nitroglycerin administration. Intravascular ultrasound and optical frequency domain imaging showed tandem intramural hematomas in the culprit vessel. We performed cutting balloon angioplasty successfully with dual intracoronary imaging modality guidance. The 4-month follow-up angiography revealed favorable vascular healing and the provocation test induced multiple spasms, including in the culprit vessel, by intracoronary acetylcholine administration. <Learning objective: Coronary artery spasm could be the cause of tandem intramural hematomas with clinical presentation of acute coronary syndrome. Angioplasty with dual imaging modality guidance is a useful option for diagnosing and treating for intramural hematoma.>.