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Updated: Sep 18, 2025

Reduction of Iatrogenic Atrial Septal Defects with an Anterior and Inferior Transseptal Puncture Site when Operating the Cryoballoon Ablation Catheter
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Reduction of Iatrogenic Atrial Septal Defects with an Anterior and Inferior Transseptal Puncture Site when Operating the Cryoballoon Ablation Catheter

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Optical Coherence Tomography-Guided Alcohol Septal Ablation for Hypertrophic Obstructive Cardiomyopathy With

Terumori Satoh1, Atsushi Sakamoto1, Ryota Sato1

  • 1Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, Hamamatsu, Japan.

JACC. Case Reports
|June 20, 2025
PubMed

Insights

Alcohol septal ablation (ASA) effectively treats hypertrophic obstructive cardiomyopathy (HOCM). Optical coherence tomography (OCT) guided ASA in a patient with a stented LAD, overcoming stent-jailed septal branches.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Medical Imaging

Background:

  • Alcohol septal ablation (ASA) is a key treatment for drug-refractory hypertrophic obstructive cardiomyopathy (HOCM).
  • Prior stent implantation in the left anterior descending artery (LAD) can complicate ASA by 'jailing' septal branches.
  • Drug-refractory HOCM presents significant challenges in patient management.

Observation:

  • A 75-year-old woman with a history of drug-eluting stent implantation experienced worsening dyspnea due to significant left ventricular outflow tract obstruction.
  • Standard pharmacotherapy failed to alleviate her symptoms, necessitating consideration of ASA.
  • Cardiac catheterization revealed that the target septal branches for ASA were jailed by stent struts.

Findings:

  • Optical coherence tomography (OCT) was employed to precisely guide the guidewire through the jailed stent struts.
  • This OCT-guided approach enabled successful ASA by navigating the complex anatomy without deforming the stent or injuring the LAD.
  • The procedure was performed without any complications, achieving the therapeutic goal.

Implications:

  • This case demonstrates the first successful application of OCT-guided ASA for stent-jailed septal branches in drug-refractory HOCM.
  • OCT provides crucial real-time visualization, enhancing safety and efficacy in complex ASA procedures.
  • The findings highlight OCT's potential to expand treatment options for HOCM patients with prior coronary stenting.

Keywords:
alcohol septal ablationhypertrophic obstructive cardiomyopathyoptical coherence tomography

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