Key result
CTO wire escalation and balloon venoplasty enable CRT reimplantation despite complete coronary sinus occlusion and dissection.
Why the study?
Coronary sinus abnormalities represent a technical challenge during CRT reimplantation after lead extraction, where complete occlusion may preclude LV lead delivery.
CTO wire escalation techniques and balloon venoplasty can be a viable percutaneous strategy to manage complete coronary sinus occlusions during CRT procedures.
Answers are grounded in this paper and cite their sources.
May support percutaneous CRT reimplantation in select occluded cases; hypothesis-generating and requires prospective validation.
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.
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Erdoğdu et al. (2026) studied this question. Using CTO wire escalation and balloon venoplasty, successful CRT reimplantation was achieved despite complete coronary sinus occlusion and dissection.
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