Application of coronary angioplasty to the septal perforator arteries

Small Septal Branch Artery Thrombus Inducing Ventricular Fibrillation: To Intervene or Not to Intervene

A 64-year-old woman presented for chest pain and was diagnosed with anteroseptal ST segment elevation myocardial infarction (STEMI). Emergent angiography showed 95% stenosis at the ostium of the second septal branch, consistent with thrombus, and no other significant lesions. The lesion was not amenable to intervention due to small caliber. Post angiography, the patient’s electrical rhythm deteriorated into ventricular fibrillation. Following resuscitation, repeat angiography confirmed same findings. Electrophysiology study at 3 months was positive for inducing fibrillation. Due to patient risk factors, she had placement of a dual chamber defibrillator. A 5-month follow-up echocardiogram showed a small area of ventricular septal wall bowing, consistent with blood supply from septal territory.

Managing Stenotic Septal Perforator Branches

Coronary artery disease of the septal perforator branches can lead to clinical ischemia and conduction abnormalities. Performing interventional procedures in these vessels is frequently impossible because they are small, which makes it difficult to approach them and to select appropriate equipment. Larger septal perforator branches have been treated percutaneously in a few patients; however, the clinical effectiveness and long-term outcomes are not known. We present our experience in managing obstructive septal perforator branch stenosis in 4 patients.

Primary percutaneous coronary intervention of an anomalous right coronary artery originating from the left sinus of valsalva

The presence of an anomalous origin of a coronary artery as the infarct related vessel during primary percutaneous coronary intervention for acute ST elevation myocardial infarction is rare and may present a technical challenge. We reported on a primary coronary percutaneous intervention performed in a right coronary artery originating from the left coronary sinus. The technical tips and tricks of treating congenital coronary anomalies are reviewed.

New catheter design for cannulation of the anomalous right coronary artery arising from the left sinus of valsalva

Cannulation of an anomalous right coronary artery during coronary angiography and percutaneous intervention poses significant technical difficulties using currently available catheter shapes. We describe a new catheter design and the cannulation technique for application of this catheter. The initial experience with this catheter in cases is reported.

Coronary stent implantation in a septal perforator artery: case report and review of the literature

Septal perforator arteries play an important role in the blood supply of the anterior interventricular septum. Their intramyocardial course makes them inaccessible for coronary bypass revascularization. Although modern catheter-based techniques might be superior to coronary bypass grafting in offering the most complete revascularization in selected patient populations, a systematic review of the literature revealed a paucity of data regarding the outcome of these patients. The present report describes coronary stent implantation in a dominant septal perforator artery and the analysis of the anatomic relationship between the stent and the intraventricular septum using a new imaging technique, catheter-based intracardiac ultrasound.

Septal perforator artery angioplasty: the advantage of application of an ultralow-profile balloon system--a case history

Coronary artery disease can affect the septal perforator arteries and cause clinical sequelae, including angina, infarction of the interventricular septum, arrhythmias, and congestive heart failure. However, the size and the course of the septal perforator arteries significantly differ from those of the major epicardial coronary vessels. These anatomic features present certain technical challenges for angioplasty of the septal arteries. This case demonstrates that application of an ultralow-profile balloon-over-the-wire system can meet the specific requirements of septal artery angioplasty and achieve adequate results.

Anomalous septal perforator artery: a source for supportive circulation in severe coronary artery disease--case reports

Anomalous origin of a septal perforator artery is an infrequent angiographic finding. However, its recognition is important in patients with coronary artery disease in order to avoid misdiagnosis and consequent management mistake. In 2 patients, coronary arteriography demonstrated an anomalous septal perforator artery supplying significant blood flow to a myocardial region previously perfused by a severely obstructed major coronary vessel. It appears that an anomalous septal artery can serve as an important source for supportive circulation in severe coronary artery disease.