Alcohol septal ablation through a bare metal stent after rotative atherectomy: a complex procedure

We report the case of a patient with severe malignant hypertrophic obstructive cardiomyopathy (HOCM) and calcified stenosis of the proximal and middle left anterior descending (LAD) coronary artery. We elected to treat his ischemic heart disease first. We performed angioplasty of the proximal and middle LAD, after rotative atherectomy, and implanted two bare metal stents. Thirty days later we treated his HOCM by alcohol septal ablation with catheterization of the first septal branch through the mesh of the bare metal stent implanted in the LAD. To our knowledge, this is the first documented report of such a procedure.