Angioplasty of the septal perforators: Acute outcome and long-term clinical efficacy

Vemuri, Dwarka N.; Kochar, Gurpreet; Maniet, Alan R.; Banka, Vidya S.

doi:10.1016/0002-8703(93)90158-6

Cited by 8 publications

(10 citation statements)

References 15 publications

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“…One approach is revascularization by means of POBA. 1,[6][7][8][9]12 In the largest relevant study (21 patients), 1 POBA of a large SPB had a 95% success rate. However, other investigators reported that intervention in the SPB can lead to acute vessel occlusion and complete heart block, either immediately or later.…”

Section: Discussionmentioning

confidence: 94%

“…bstructive coronary artery disease (CAD) of the septal perforator branches (SPBs) off the left anterior descending coronary artery (LAD) can be expected in association with CAD of the major epicardial vessels. 1 Atherosclerotic occlusion of a relatively large SPB can lead to ischemia, conduction abnormalities, and arrhythmias. [2][3][4][5] Revascularization by means of percutaneous coronary intervention (PCI) to the SPBs can be technically challenging when the SPBs have a caliber <2 mm or a sharply angulated takeoff, because it is difficult to deliver devices of appropriate size.…”

mentioning

confidence: 99%

“…[2][3][4][5] Revascularization by means of percutaneous coronary intervention (PCI) to the SPBs can be technically challenging when the SPBs have a caliber <2 mm or a sharply angulated takeoff, because it is difficult to deliver devices of appropriate size. Various approaches to PCI, with or without SPB stenting, have been reported [1][2][3][6][7][8][9][10] ; however, their clinical effectiveness and long-term outcomes are not known. 1 Existing guidelines lack recommendations for interventions in diseased SPBs.…”

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confidence: 99%

“…Various approaches to PCI, with or without SPB stenting, have been reported [1][2][3][6][7][8][9][10] ; however, their clinical effectiveness and long-term outcomes are not known. 1 Existing guidelines lack recommendations for interventions in diseased SPBs. We present our experience in managing SPB stenosis in 4 patients.…”

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confidence: 99%

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Managing Stenotic Septal Perforator Branches

Saidi¹,

Tandar²,

Welt³

et al. 2017

Texas Heart Institute Journal

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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.

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Section: Discussionmentioning

confidence: 94%

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confidence: 99%

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confidence: 99%

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confidence: 99%

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Managing Stenotic Septal Perforator Branches

Saidi¹,

Tandar²,

Welt³

et al. 2017

Texas Heart Institute Journal

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“…Angiography with PCI has shown some success, although current literature suggests that in-stent stenosis rates are elevated when compared with stenting of other coronary vessels. 2,4,7,8 Unfortunately, there is currently no role for coronary artery bypass grafting given the inaccessible, interior course of these arteries. Case reports have suggested a possibility for aspiration thrombectomy as a solution, although further research is needed before this option is used more widely.…”

Section: Discussionmentioning

confidence: 99%

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

Agarwal

Olson

Mroue

et al. 2019

Clin Med Insights Case Rep

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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.

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Rotational atherectomy for left anterior descending artery septal perforator stenosis

Cohen

Khosla

Levin

et al. 1999

Cathet. Cardiovasc. Intervent.

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Stenosis in large septal perforators can result in significant clinical ischemia. The distribution of the septal arteries is as large as many more commonly treated branch vessels. The interventricular septal blood supply has been ignored as a target for revascularization due to its inaccessibility for surgical revascularization, and the elastic recoil associated with balloon angioplasty in this location. Rotational atherectomy is a new therapeutic option for revascularization in this previously difficult location. The septal perforator ostium is the most common site of lesions and is functionally a branch ostial stenosis. We describe four cases in which rotational atherectomy was performed in patients with reversible ischemia due to septal artery stenosis. The acute angiographic results were stable, without evidence for immediate recoil. By debulking, facilitated angioplasty can yield stable acute results in this location. The small size of most septal branches and their angulated origin make rotational atherectomy challenging, and cases must be selected carefully. This previously ignored lesion location can be considered for revascularization in patients with suitable lesion and vessel morphology. Cathet. Cardiovasc. Intervent. 46:79–82, 1999. © 1999 Wiley‐Liss, Inc.

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Angioplasty of the septal perforators: Acute outcome and long-term clinical efficacy

Cited by 8 publications

References 15 publications

Managing Stenotic Septal Perforator Branches

Managing Stenotic Septal Perforator Branches

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

Rotational atherectomy for left anterior descending artery septal perforator stenosis

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