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Microcoil embolisation for ablation of septal hypertrophy in hypertrophic obstructive cardiomyopathy
Mihai Iacob1, Florina Pinte, Ion Tintoiu
1Army Center for Cardiovascular Diseases, Bucharest, Romania.
Insights
Microcoil embolization effectively treats hypertrophic obstructive cardiomyopathy (HOCM) by occluding septal arteries. This safe procedure reduces pressure gradients and improves symptoms without alcohol-related risks.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Devices
Background:
- Hypertrophic obstructive cardiomyopathy (HOCM) is a condition characterized by thickened heart muscle.
- Percutaneous transcatheter occlusion using ethanol injection has been an established treatment for HOCM.
- Septal artery embolization offers an alternative approach to managing HOCM.
Purpose of the Study:
- To evaluate the feasibility and efficiency of septal artery embolization using microcoils in patients with HOCM.
- To assess the impact of microcoil embolization on intraventricular pressure gradients.
- To compare the safety and efficacy of microcoil embolization with ethanol injection.
Main Methods:
- Microcoils were delivered via a coaxial balloon catheter into the target septal arteries.
- Complete flow obstruction was achieved using 0.018"-straight microcoils.
- Intraventricular pressure gradients were measured pre- and post-procedure; coronary angiography confirmed occlusion.
Main Results:
- Seven symptomatic HOCM patients (NYHA class III/IV) were treated successfully without complications.
- Mean pressure gradient decreased from 72 mmHg to 30 mmHg during the procedure and 34 mmHg post-procedure.
- All patients showed clinical improvement (NYHA class I/II) with no need for permanent pacing.
Conclusions:
- Microcoil embolization is a safe and effective transcatheter method for ablating septal hypertrophy in HOCM.
- This technique induces myocardial necrosis without alcohol's toxic effects.
- It reduces risks associated with ethanol injection, such as permanent pacemaker implantation or off-target effects.
Background And Aim:
Percutaneous transcatheter occlusion with ethanol injection of septal arteries is an efficient treatment procedure of hypertrophic obstructive cardiomyopathy (HOCM). The aim of our study was to evaluate the feasibility and efficiency of septal artery embolisation with microcoils.
Methods:
Microcoils were delivered through the guide-wire lumen of a 2mm-diameter coaxial balloon positioned inside the target vessel as distally as possible. One or more 0.018"-straight microcoils (Hilal straight coils, Cook, USA) were used for each target vessel until complete flow obstruction was achieved. The intraventricular pressure gradient was measured before, during and after the procedure. Septal branch occlusion was finally documented by coronary angiography.
Results:
We treated 7 patients (5 males; mean age: 48 +/- 10 years). All patients were symptomatic (NYHA class III or IV). The target vessels were successfully occluded in all patients without complications. Moderate pain was recorded during and after the procedure and the CK level increased five- to ten-fold. The pressure gradient diminished during the procedure from 72 +/- 21 mmHg to 30 +/- 15 mmHg. The number of coils delivered ranged from 3 to 7 per patient. The embolised septal branches included 1 vessel in 5 patients, 2 vessels in 1 patient and 3 vessels in 1 case. After the procedure, the pressure gradient, evaluated by transthoracic echocardiography, was 34 +/- 16 mmHg and 42 +/- 12 mmH at 3 month-follow-up. Clinical improvement was recorded in all patients after the procedure (NYHA class I or II). Temporary pacing was necessary in 3 patients during and immediately after the procedure but no patient needed permanent pacing.
Conclusions:
Microcoil embolisation is an efficient and safe approach for transcatheter ablation of septal hypertrophy in HOCM. This technique induced myocardial necrosis without the toxic effects of alcohol, reducing the risk of complications such as permanent pacemaker implantation or ethanol flow to other myocardial regions.
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