title: Percutaneous coronary sinus interventions to facilitate implantation of left ventricular lead: a case series and review of literature.
abstract: BACKGROUND
  Valves, stenosis, and occlusion in the coronary sinus (CS) may affect the success of left ventricular (LV) lead implantation in cardiac resynchronization therapy (CRT). We present our experience in percutaneous CS intervention (PCSI) to facilitate LV lead implantation and stabilization.
  
  
  RESULTS
  Transvenous LV lead implantation was attempted for CRT in a total of 255 patients (mean age 61.0 ± 12.5 y; 60 female, 160 ischemic etiologies) from January 2005 to November 2010. Seventeen patients (6.7%) needed PCSI. PCSI indications were stenosis in 10 patients, CS valve in 5 patients, chronic venous occlusion in 1 patient, and LV lead stabilization in 1 patient. CS angioplasty was performed in 16 patients (6.2%) and stenting in 3 patients (1.2%) to facilitate LV lead placement. Two patients needed both balloon angioplasty and stenting. LV leads were successfully inserted in 15/17 (88.2%) of the patients who needed PCSI. There were no complications related to PCSI. The overall success rate of LV lead implantation increased from 238/255 (93.3%) to 253/255 (99.2%) with the use of PCSI.
  
  
  CONCLUSIONS
  PCSI is a useful and safe technique in transvenous LV lead placement in case of CS stenosis, valves, and lead instability.
authors.affiliation: Department of Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey.
authors.forename: Ali
authors.initials: A
authors.lastname: Oto
authors.forename: Kudret
authors.initials: K
authors.lastname: Aytemir
authors.forename: Sercan
authors.initials: S
authors.lastname: Okutucu
authors.forename: Ugur
authors.initials: U
authors.lastname: Canpolat
authors.forename: Levent
authors.initials: L
authors.lastname: Sahiner
authors.forename: Hilmi
authors.initials: H
authors.lastname: Ozkutlu
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D058406:Cardiac Resynchronization Therapy; D058409:Cardiac Resynchronization Therapy Devices; D054326:Coronary Sinus; D004567:Electrodes, Implanted; D005240:Feasibility Studies; D005260:Female; D006333:Heart Failure / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged