Coronary angioplasty of septal perforator

Application of coronary angioplasty to the septal perforator arteries

“…Therefore, whenever possible, the management of reclosure should be repeat angioplasty [8]. Angioplasty achieved good results in all our 11 patients as well as in the 5 other cases known to us through a literature search [7,9,10,11]. The restenosis rate, based on follow-up angiograms in only 4 of our patients, is probably similar to that observed in angioplasty of the major coronary arteries.…”

“…When such difficulties arise, several techniques can be applied to allow successful completion of the angioplasty procedure: first, it is recommended to accentuate the J tip of the guidewire and to use more rigid, steerable wires. Second, deep engagement of the guiding catheter can manipulate the guidewire to pass into the septal perforator artery [7]. Alternatively, as is shown in 3 of our patients, a nonover-the-wire system can be utilized, thereby avoiding "trackability" problems of over-the-wire systems.…”

Managing Stenotic Septal Perforator Branches

“…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.…”

“…[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.…”

Anatomy of the septal perforating arteries of the heart

“…PCI has a considerable evidence base and is firmly established as the most common procedure used in the invasive treatment of patients with chronic heart disease, and when patients present with lesion in the left coronary artery, reduced antegrade coronary flow and clinical instability, PCI should be considered first [35]. Although the main septal perforating artery branches off from the anterior interventricular artery at an acute angle of 45° to 90° [21,36], accessing into the occluded main septal perforating artery is technically feasible with a steerable guidewire [37,38]. There are many cases of the successful PCI of the main septal perforating artery in the literature [36][37][38][39][40][41].…”