Successful CRT Reimplantation After Coronary Sinus Total Occlusion Using CTO Wire Escalation Techniques: A Case
Onur Umut Erdoğdu1, Muhammed Rıdvan Ersoysal1
1Department of Cardiology, Antalya Training and Research Hospital, Antalya, Turkey.
Insights
Successfully reimplanting cardiac resynchronization therapy (CRT) leads after extraction is challenging with coronary sinus (CS) occlusion. This case demonstrates a successful percutaneous approach to CRT reimplantation despite complete CS occlusion.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Electrophysiology
Background:
- Coronary sinus (CS) abnormalities pose significant challenges for cardiac resynchronization therapy (CRT) reimplantation after transvenous lead extraction.
- Complete CS occlusion can prevent left ventricular (LV) lead placement, often requiring alternative pacing or surgical solutions.
Abstract:
Coronary sinus (CS) abnormalities represent a major technical challenge during cardiac resynchronization therapy (CRT) reimplantation following transvenous lead extraction. Complete CS occlusion may preclude left ventricular (LV) lead delivery and often necessitates alternative pacing strategies or surgical epicardial lead placement. We report a case of successful CRT reimplantation in a patient with complete CS occlusion encountered during a right-sided approach. The occlusion was crossed using a stepwise guidewire escalation strategy adapted from chronic total occlusion (CTO) percutaneous coronary intervention techniques, followed by sequential balloon venoplasty. Despite the occurrence of a long-segment CS dissection, the LV lead was successfully advanced and implanted with stable electrical parameters. This case illustrates that selected CS occlusions during CRT procedures may be managed percutaneously using contemporary interventional tools and techniques.
