Percutaneous Coronary Intervention and Stenting for the Treatment of Myocardial Muscle Bridges: A Consecutive Case Series

BACKGROUND: Myocardial muscle bridging is not uncommon; it is usually asymptomatic and on occasion can be associated with angina or even acute coronary syndrome. Traditionally, percutaneous intervention is not advocated and medical management or cardiac surgery, with unroofing of the bridge, is advised if troublesome symptoms occur. OBJECTIVE: To describe the experience and outcome of percutaneous intervention and stenting of symptomatic myocardial muscle bridges. METHODS: A retrospective analysis of prospectively collected data on all patients with symptomatic muscle bridge who were treated with stent insertion after physiologic and intravascular ultrasound assessment was performed. Follow-up of all patients up to 7 years was documented and repeat angiography was performed in 4 of these patients. RESULTS: Seven patients were identified with muscle bridge who were symptomatic and were managed with maximum medical therapy but remained symptomatic. They all underwent percutaneous procedure with physiologic assessment of the muscle bridge with fractional flow reserve and with intravascular ultrasound, which was also used to optimize the stent procedure. All patients remain well and asymptomatic with follow-up from 2-7 years. Two patients had atypical symptoms and had repeat angiography at 18 and 28 months, respectively, and 2 more patients had a follow-up angiography at 32 and 34 months; all showed patent stents and no evidence of any issues. CONCLUSION: Percutaneous intervention and stent for symptomatic muscle bridges performed with physiological and intracoronary imaging assessment and guidance may be an acceptable management modality for symptomatic MB patients, resulting in a good outcome and potentially sparing patients a highly invasive cardiac surgery.