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Microcoil embolization for ablation of septal hypertrophy in hypertrophic obstructive cardiomyopathy
Insights
Microcoil embolization effectively treats hypertrophic obstructive cardiomyopathy (HOCM) by safely reducing the intraventricular pressure gradient. This minimally invasive procedure offers a viable alternative to ethanol injection, improving patient symptoms and avoiding alcohol-related complications.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Devices
Background:
- Hypertrophic obstructive cardiomyopathy (HOCM) is often treated with percutaneous transcatheter alcohol septal ablation.
- Ethanol injection carries risks, including potential complications like permanent pacemaker implantation and unintended ethanol spread.
Purpose of the Study:
- To evaluate the feasibility and efficacy of using microcoils for septal artery embolization in HOCM patients.
- To compare microcoil embolization with traditional ethanol injection methods.
Main Methods:
- Microcoils were delivered via a coaxial balloon catheter positioned distally in the target septal artery.
- Complete flow obstruction was achieved using 0.018" straight microcoils.
- Intraventricular pressure gradient was measured pre- and post-procedure; septal branch occlusion confirmed by angiography.
Main Results:
- Successful occlusion of target septal arteries in all 7 treated HOCM patients without immediate complications.
- Significant reduction in intraventricular pressure gradient from 72 ± 21 mm Hg to 30 ± 15 mm Hg during the procedure, and 34 ± 16 mm Hg post-procedure.
- All patients experienced clinical improvement (NYHA class 1 or 2) 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 targeted myocardial necrosis, avoiding the systemic toxicity and risks associated with ethanol ablation.
- Microcoil embolization offers a reduced risk of complications compared to alcohol septal ablation.
Background:
Percutaneous transcatheter occlusion with ethanol injection of septal arteries is an efficient treatment procedure of hypertrophic obstructive cardiomyopathy (HOCM). The aim of our study is to evaluate the feasibility and efficiency of septal artery embolization with microcoils.
Methods:
The 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 noted. 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 (pts) (male: 5 pts; mean age: 48 (10 years). All patients were symptomatic (NYHA class 3 or 4). 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 mm Hg to 30 +/- 15 mm Hg. The number of coils delivered ranged from 3 to 7 / patient. The embolized septal branches: 1 vessel in 5 patients; 2 vessels in 1 patient; 3 vessels in 1 case. After the procedure the pressure gradient, evaluated by transthoracic echocardiography, was 34 +/- 16 mm Hg and 42 +/- 12 mm Hg at 3 month-follow-up. Clinical improvement was recorded in all patients after the procedure (NYHA class 1 or 2). Temporary pacing was necessary in 3 patients during and immediately after the procedure but no patient needed permanent pacing.
Conclusions:
Microcoil embolization 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 (permanent pace-maker implantation, ethanol flow to other myocardial regions).
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