A multistage strategy of perfusion SPECT and CT pulmonary angiogram in balloon pulmonary angioplasty for totally occluded lesions

Figure 1. Multistaged BPA strategy with multimodalities for a total occlusion. A) Three-dimensional perfusion SPECT/CTPA fusion image. B) Volume-rendered image of CTPA. C) CTPA-MIP image. D) MIP-guided BPA.

A 56-year-old man with chronic thromboembolic pulmonary hypertension (CTEPH) was admitted to our hospital. Balloon pulmonary angioplasty (BPA) performed twice decreased the mean pulmonary artery pressure (PAP) from 37 to 20 mmHg and pulmonary vascular resistance (PVR) from 3.2 to 2.7 Wood units. However, he showed persistent exercise intolerance (World Health Organization [WHO] functional class III). We performed perfusion single photon emission computed tomography (SPECT) and CT pulmonary angiography (CTPA) and found some residual ...