Optical Coherence Tomography-Guided Alcohol Septal Ablation for Hypertrophic Obstructive Cardiomyopathy With Stent-Jailed Septal Branches.

Alcohol septal ablation (ASA) is an effective treatment for drug-refractory hypertrophic obstructive cardiomyopathy (HOCM). However, with prior stent implantation in the left anterior descending artery (LAD), target septal branches can be jailed by a stent, complicating the procedure. A 75-year-old woman with a history of drug-eluting stent implantation was referred for worsening dyspnea. Echocardiography and cardiac catheterization revealed significant left ventricular outflow tract obstruction. Inasmuch as pharmacotherapy failed to control her symptoms, ASA was planned. The target septal branches were jailed by the stent strut. To prevent stent deformation and donor LAD injury during balloon catheter insertion and removal, optical coherence tomography (OCT) was used to guide the guidewire through the appropriate crossing point of the jailed struts, enabling ASA without complications. This is the first report of ASA for stent-jailed septal branches under OCT guidance in drug-refractory HOCM, demonstrating the usefulness of OCT in ASA with stent-jailed target septal branches.