Coronary Sinus Venoplasty Using Cutting Balloon for Left Ventricular Lead Placement

Coronary Sinus Venous stenosis is rare; however, it is often encountered during left ventricular (LV) lead implantation, which is the cornerstone of cardiac resynchronization therapy (CRT). Plain balloon angioplasty and anchor balloon technique have been described for LV lead implantation in patients with venous stenosis and tortuous anatomy. We investigate the efficacy of coronary vein angioplasty using a cutting balloon to facilitate the implantation of LV lead.

452 patients who underwent standard CRT implantation from 2015 to 2024 were studied retrospectively. 21 patients (4.64%) had significant venous stenosis in the posterolateral vein, which required venous intervention to facilitate lead placement. Seven patients required cutting balloon dilatation for focal venous stenosis in which balloon dilation and anchor balloon technique failed.

All seven patients had successful LV lead implantation in the target vein following cutting balloon venoplasty. There was no complication during the procedure and long-term lead parameters were excellent.

Coronary vein angioplasty using a cutting balloon is an effective and safe technique to facilitate LV pacing lead placement in case of target vein stenoses.