INTERVENTIONAL FLASHLIGHT

DOI: 10.4244/EIJ-D-17-00382

Stepwise optimisation of balloon pulmonary angioplasty in a patient with severe non-operable chronic thromboembolic pulmonary hypertension

Aleksander Araszkiewicz*, MD, PhD; Stanislaw Jankiewicz, MD, PhD; Tatiana Mularek-Kubzdela, MD, PhD; Maciej Lesiak, MD, PhD

Balloon pulmonary angioplasty (BPA) is a developing method for the treatment of patients with inoperable chronic thromboembolic pulmonary hypertension (CTEPH); however, the optimal technique of the procedure is still the subject of debate1.

A 50-year-old female with non-operable peripheral type CTEPH (San Diego classification type 3) (Moving image 1, Moving image 2) with World Health Organization (WHO) class III dyspnoea and with a mean pulmonary artery pressure (mPAP) of 58 mmHg underwent a BPA session. The left A10 segmental artery was subtotally occluded (Panel Aa). Optical coherence tomography (OCT) (DragonFly™; St. Jude Medical, St. Paul, MN, USA) revealed intravascular colander-like structures (Panel Ab). Considering the very high mPAP, resulting in a high risk of post-reperfusion injury, a 2.0×20 mm angioplasty balloon was inflated (Panel Ac). One month later, remarkable dilation of the treated vessel was visible (Panel Ba). However, a significant pressure gradient through the treated lesion was revealed (Panel Bb). Hence, optimisation with a 3.5×20 mm balloon was performed and the peripheral pressure reached 37 mmHg (Panel Bc, Panel Bd). Three months later, the artery was significantly dilated, although no additional treatment was performed at the lesion (Panel Ca). OCT revealed positive remodelling of the artery, healed dissection and compressed mural lesions (Panel Cb, Moving image 3). Moreover, the pressure gradient across the lesion was eliminated (Panel Cc). After the next three BPA sessions, mPAP was reduced to 34 mmHg and no complications were observed.

A stepwise increase of perfusion pressure in the pulmonary artery distal to the occlusion site with partial detachment of the organised thrombi may be due to dilation of the pulmonary artery over time and positive remodelling of the vessel2. Thus, the immediate elimination of the pressure gradient may not be necessary for the long-term success of BPA, especially in patients with very high pulmonary pressure. Although imaging and physiological measures are generally known to be of value, this report shows how to incorporate them clinically for individual patient care. A multimodality approach to the treated lesions might be helpful in the proper planning and optimising of the procedure.

Conflict of interest statement

The authors have no conflicts of interest to declare.

Supplementary data

Moving image 1. Left pulmonary artery angiography.

Moving image 2. Right pulmonary artery angiography.

Moving image 3. Optical coherence tomography co-registration three months after balloon pulmonary angioplasty.

Supplementary data

To read the full content of this article, please download the PDF.

Moving image 1. Left pulmonary artery angiography.

Moving image 2. Right pulmonary artery angiography.

Moving image 3. Optical coherence tomography co-registration three months after balloon pulmonary angioplasty.

Volume 13 Number 14
Feb 20, 2018
Volume 13 Number 14
View full issue


Key metrics

Suggested by Cory

Image – Interventional flashlight

10.4244/EIJ-D-18-01212 Oct 4, 2019
Balloon pulmonary angioplasty for the treatment of chronic thromboembolic pulmonary hypertension
Räber L et al
free

10.4244/EIJV12SXA8 May 16, 2016
Percutaneous treatment of chronic thromboembolic pulmonary hypertension (CTEPH)
Muller DW and Liebetrau C
free

Clinical Research

10.4244/EIJ-D-21-00230 Jan 28, 2022
Balloon pulmonary angioplasty in chronic thromboembolic pulmonary hypertension: a multicentre registry
Darocha S et al
free
Trending articles
152.9

Clinical research

10.4244/EIJ-D-20-01125 Oct 20, 2021
An upfront combined strategy for endovascular haemostasis in transfemoral transcatheter aortic valve implantation
Costa G et al
free
47.8

NEW INNOVATION

10.4244/EIJ-D-15-00467 Feb 20, 2018
Design and principle of operation of the HeartMate PHP (percutaneous heart pump)
Van Mieghem NM et al
free
39.1

Clinical research

10.4244/EIJ-D-22-00558 Feb 6, 2023
Permanent pacemaker implantation and left bundle branch block with self-expanding valves – a SCOPE 2 subanalysis
Pellegrini C et al
free
38.95

State-of-the-Art

10.4244/EIJ-D-23-00912 Oct 7, 2024
Optical coherence tomography to guide percutaneous coronary intervention
Almajid F et al
free
X

The Official Journal of EuroPCR and the European Association of Percutaneous Cardiovascular Interventions (EAPCI)

EuroPCR EAPCI
PCR ESC
Impact factor: 7.6
2023 Journal Citation Reports®
Science Edition (Clarivate Analytics, 2024)
Online ISSN 1969-6213 - Print ISSN 1774-024X
© 2005-2024 Europa Group - All rights reserved