Managing Stenotic Septal Perforator Branches

Abstract

Coronary artery disease of the septal perforator branches can lead to clinical ischemia and conduction abnormalities. Performing interventional procedures in these vessels is frequently impossible because they are small, which makes it difficult to approach them and to select appropriate equipment. Larger septal perforator branches have been treated percutaneously in a few patients; however, the clinical effectiveness and long-term outcomes are not known. We present our experience in managing obstructive septal perforator branch stenosis in 4 patients.

Keywords: Angioplasty, balloon, coronary/methods; atherectomy, coronary; coro nary circulation/physiology; coronary occlusion/etiology/therapy; coronary stenosis/therapy; coronary vessels/pathology; risk factors; stents; treatment outcome.

Fig. 1.

Patient 1. Coronary angiograms (right anterior oblique views) show A) critical ostial stenosis in the first septal perforator branch, and B) resolution after balloon angioplasty.

Fig. 2.

Patient 2. Coronary angiograms (right anterior oblique views) show A) severe stenosis in the mid left anterior descending coronary artery (LAD) and 50% ostial stenosis in the first septal perforator branch (arrow), B) acute occlusion of the branch after LAD intervention, and C) resolution after balloon angioplasty.

Fig. 3.

Patient 3. Coronary angiograms (left anterior oblique views) show A) substantial ostial stenosis of the first septal perforator branch, and B) resolution after balloon angioplasty.

Fig. 4.

Patient 4. Coronary angiogram (right anterior oblique view) shows subtotal occlusion of the first septal perforator branch, which exhibits Thrombolysis in Myocardial Infarction II flow.