Coronary Sinus Venoplasty Using Cutting Balloon for Left Ventricular Lead Placement

Area of Science:

• Cardiology
• Interventional Cardiology
• Medical Devices

Background:

• Coronary venous stenosis is a rare but significant challenge during left ventricular (LV) lead implantation for cardiac resynchronization therapy (CRT).
• Standard techniques like balloon angioplasty and anchor balloons have limitations in managing venous stenosis and tortuous anatomy.

Purpose of the Study:

• To evaluate the efficacy and safety of using a cutting balloon for coronary vein angioplasty to facilitate LV lead implantation in patients with venous stenosis.

Main Methods:

• Retrospective study of 452 patients undergoing CRT implantation (2015-2024).
• Identified 21 patients (4.64%) with significant posterolateral vein stenosis requiring intervention.
• Seven patients with failed balloon dilation/anchor balloon techniques underwent cutting balloon angioplasty.

Main Results:

• Successful LV lead implantation was achieved in all seven patients treated with cutting balloon venoplasty.
• No procedural complications were reported.
• Excellent long-term lead parameters were observed.

Conclusions:

• Coronary vein angioplasty with a cutting balloon is a safe and effective method for overcoming target vein stenoses.
• This technique facilitates successful LV pacing lead placement in challenging anatomies.