Key result
Cutting balloons achieve 100% LV lead implantation success in coronary venous stenosis after standard techniques fail.
Why the study?
Coronary sinus venous stenosis hinders left ventricular lead implantation during CRT, prompting investigation into cutting balloon angioplasty when plain and anchor balloon techniques fail.
Does coronary vein angioplasty using a cutting balloon improve successful LV lead implantation in patients with focal venous stenosis refractory to standard balloon techniques?
Cohort (n=452)
Does coronary vein angioplasty using a cutting balloon improve successful LV lead implantation in patients with focal venous stenosis refractory to standard balloon techniques?
Cutting balloon venoplasty is a safe and effective rescue technique to facilitate LV lead placement during CRT implantation when standard balloon angioplasty fails due to venous stenosis.
May facilitate LV lead placement after failed standard angioplasty; leaves open confirmation in larger prospective cohorts.
BACKGROUND: Coronary Sinus Venous stenosis is rare; however, it is often encountered during left ventricular (LV) lead implantation, which is the cornerstone of cardiac resynchronization therapy (CRT). Plain balloon angioplasty and anchor balloon technique have been described for LV lead implantation in patients with venous stenosis and tortuous anatomy. We investigate the efficacy of coronary vein angioplasty using a cutting balloon to facilitate the implantation of LV lead. METHODS: 452 patients who underwent standard CRT implantation from 2015 to 2024 were studied retrospectively. 21 patients (4.64%) had significant venous stenosis in the posterolateral vein, which required venous intervention to facilitate lead placement. Seven patients required cutting balloon dilatation for focal venous stenosis in which balloon dilation and anchor balloon technique failed. RESULTS: All seven patients had successful LV lead implantation in the target vein following cutting balloon venoplasty. There was no complication during the procedure and long-term lead parameters were excellent. CONCLUSION: Coronary vein angioplasty using a cutting balloon is an effective and safe technique to facilitate LV pacing lead placement in case of target vein stenoses.
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Shah et al. (2025) conducted a cohort in Coronary Sinus Venous stenosis during CRT implantation (n=452). Coronary vein angioplasty using a cutting balloon was evaluated on Successful LV lead implantation in the target vein. Coronary vein angioplasty using a cutting balloon achieved 100% successful left ventricular lead implantation in 7 patients with focal venous stenosis where standard balloon techniques failed.
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