A Road Less Traveled: Successful Alcohol Septal Ablation via an Aberrant Septal Coronary Artery in Hypertrophic...

Area of Science:

• Cardiology
• Interventional Cardiology
• Cardiac Imaging

Background:

• Alcohol septal ablation (ASA) is a key treatment for symptomatic hypertrophic obstructive cardiomyopathy (HOCM).
• Patient selection for ASA requires detailed pre-procedural anatomical assessment.
• Identifying the correct septal artery is crucial for successful ASA and left ventricle outflow tract (LVOT) obstruction management.

Purpose of the Study:

• To present a case of successful ASA in a patient with HOCM using an aberrant septal perforator.
• To highlight the importance of evaluating complex coronary artery anatomy in HOCM patients undergoing ASA.
• To underscore that non-LAD originating vessels do not exclude ASA candidacy but require careful assessment.

Main Methods:

• Review of a single HOCM patient case undergoing ASA.
• Pre-procedural coronary angiography to assess septal artery origin and anatomy.
• Performance of ASA targeting an aberrant septal perforator originating from the ramus intermedius.

Main Results:

• Successful ASA was achieved by targeting a septal perforator arising from the ramus intermedius, not the typical left anterior descending artery (LAD).
• The patient experienced symptomatic improvement post-procedure.
• The case demonstrates successful intervention despite atypical coronary anatomy.

Conclusions:

• Complex and variable coronary anatomy, including non-LAD origins of septal perforators, is encountered in HOCM patients.
• Thorough pre-procedural anatomical evaluation is essential for safe and effective ASA.
• Aberrant septal perforators can be successfully targeted for ASA, expanding treatment options for HOCM patients.