AUTHOR=Mandic Aleksandar , Vidovic Gorica , Radoicic Dragana , Ilic Ivan 

TITLE=Micro-coil embolization for transcatheter septal ablation in a hypertrophic obstructive cardiomyopathy patient and an unusual coronary anatomy: a case report

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 12 - 2025

YEAR=2025

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2025.1637475

DOI=10.3389/fcvm.2025.1637475

ISSN=2297-055X

ABSTRACT=BackgroundTranscatheter septal ablation is a minimally invasive therapeutic method for treating symptomatic obstructive hypertrophic cardiomyopathy (HCM). The procedure is an alternative to septal myectomy, and it can be achieved using different modalities. Coronary artery congenital anomalies can coexist with HCM and can add complexity to its treatment.Case summaryA 65-year-old female presented with angina, reduced exercise tolerance, palpitations, and dizziness. Echocardiography showed eccentric left ventricular hypertrophy with basal septal thickness of 20 mm and left ventricular outflow tract (LVOT) obstruction with maximum gradient of 209 mmHg. Cardiopulmonary exercise stress test showed a decreased oxygen uptake (VO2) of 13.7 ml/min/m2. Medical therapy titrated to maximum tolerated doses failed and septal reduction therapy was indicated. Prior to alcohol septal ablation (ASA), coronary angiography revealed a rare coronary artery anomaly, a single coronary artery originating from the right coronary sinus and the procedure was unsuccessful due to kinking of the over-the-wire (OTW) balloon, caused by the acute take-off angle of the septal branch. The second attempt was done using a microcatheter that was advanced to the septal branch over a hydrophilic coronary guidewire and embolization was done with two micro-coils 2mm × 2 cm. Procedural echocardiography revealed basal septal akinesia and reduced LVOT velocity from 7.24 m/s to 1.5 m/s. After six months, the patient reported a decreased frequency of chest pain and improved exercise tolerance. Echocardiography revealed the septal thickness of 15 mm, with an LVOT gradient of 24 mmHg. Follow-up CT coronary angiography confirmed a “single” coronary artery type R-III, with separate origins of LAD and Cx from the proximal RCA. Part of LAD went through the interventricular septum, forming a myocardial bridge, classified as a potentially “malignant” S subtype.ConclusionMicro-coil embolization is a feasible alternative treatment to alcohol septal ablation in patients with obstructive HCM and anomalous origin and the course of coronary arteries.