CASE REPORT article
Front. Cardiovasc. Med.
Sec. Cardiovascular Imaging
This article is part of the Research TopicCardiovascular Imaging Case Reports 2025: Emphasizing Uncommon Clinical ScenariosView all 12 articles
Micro-coil embolization for transcatheter septal ablation in a hypertrophic obstructive cardiomyopathy patient and an unusual coronary anatomy: a case report
Provisionally accepted
- 1Department of cardiology,, Institute for Cardiovascular Diseases Dedinje, Belgrade, Serbia
- 2Department of Non-Invasive Radiological Diagnostics, Institute for Cardiovascular Diseases Dedinje, Belgrade, Serbia
- 3Department of cardiology, Institute for Cardiovascular Diseases Dedinje, Belgrade, Serbia
- 4Univerzitet u Beogradu Medicinski fakultet, Belgrade, Serbia
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Background: Transcatheter 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 Summary: A 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 x 2cm. Procedural echocardiography revealed basal septal akinesia and reduced LVOT velocity from 7.24m/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 15mm, 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. Conclusion Micro-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.
Keywords: alcohol septal ablation, Hypertrophic Cardiomyopathy, Micro-coil, "single" coronary artery, Coronary anomaly
Received: 29 May 2025; Accepted: 27 Oct 2025.
Copyright: © 2025 Mandic, Vidovic, Radoicic and Ilic. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Gorica Vidovic, gorica_vidovic@yahoo.com
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