PMC6037626_01
Venography of the coronary sinus (CS) in the shallow left anterior oblique projection. During the process of cardiac resynchronization therapy, injection in the CS via the guiding catheter (GC) illustrates the CS anatomy for appropriate CS lead placement. The right ventricular lead is shown with the vertical arrow.
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F1
CS delivery system was introduced into the CS through the left subclavian vein. CS angiography revealed an unsuitable venous branch in the lateral area (Figure 1), but the posterolateral branch had an acceptable size and anatomy.
Coronary sinus (CS) lead stabilization with stenting is shown in the shallow left anterior oblique projection. The coronary sinus lead and a 0.014-inch guide wire are both passed through the guiding catheter. The CS lead is stabilized and entrapped by stenting the CS.
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F2
The stent was deployed at a nominal pressure (10 atm) 3 cm distal to the venous branch takeoff, and the distal part of the stent was 1 cm before the LV ring (Figure 2).
PMC6037626_02
Coronary sinus (CS) venography in the shallow left anterior oblique projection. CS injection is performed via a guiding catheter to clarify the appropriate site for CS lead placement.
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F3
CS venography, an LV lead (QuickFlex 1258T-86) was implanted in the lateral marginal branch, but the procedure was unsuccessful due to the small size of the venous branch (Figure 3). Consequently, the LV lead was repositioned in the posterolateral branch of the CS.
Stent deployment to stabilize the coronary sinus (CS) lead in the right anterior oblique projection. In this image, CS lead stabilization is shown with stent deployment.
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F4
LV lead stabilization was accomplished by the deployment of a bare-metal stent (Multi-Link 3.5 x 8 mm, Abbott Vascular) about 4 cm before the LV lead ring in order to entrap it (Figure 4).