Abstract
BACKGROUND: Obstructive hypertrophic cardiomyopathy often requires septal reduction in symptomatic patients, but standard alcohol septal ablation may be limited in some cases. CASE SUMMARY: A 72-year-old woman presented with dyspnea and syncope. Investigations revealed dynamic left ventricular outflow tract gradient up to 167 mm Hg. Targeted embolization using ethylene-vinyl alcohol copolymer on septal and circumflex branches achieved complete gradient resolution. DISCUSSION: This case demonstrates polymer-based embolization as a feasible alternative for complex cases, offering precise targeting beyond traditional septal branches, aligned with current guidelines for nonsurgical candidates. TAKE-HOME MESSAGES: Polymer embolization provides effective left ventricular outflow tract relief in obstructive hypertrophic cardiomyopathy with atypical supply. Functional balloon testing optimizes outcomes in high-risk patients.