Balloon Pulmonary Angioplasty with Stent Implantation as a Treatment of Proximal Chronic Thromboembolic Pulmonary Hypertension
Szymon Darocha,
Radosław Pietura,
Marta Banaszkiewicz,
Arkadiusz Pietrasik,
Łukasz Kownacki,
Adam Torbicki,
Marcin Kurzyna
Affiliations
Szymon Darocha
Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, Fryderyk Chopin Hospital in European Health Center Otwock, 05-400 Otwock, Poland
Radosław Pietura
Department of Radiography, Medical University of Lublin, 20-081 Lublin, Poland
Marta Banaszkiewicz
Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, Fryderyk Chopin Hospital in European Health Center Otwock, 05-400 Otwock, Poland
Arkadiusz Pietrasik
1st Chair and Department of Cardiology, Medical University of Warsaw, 02-087 Warsaw, Poland
Łukasz Kownacki
Department of Radiology, European Health Center Otwock, 05-400 Otwock, Poland
Adam Torbicki
Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, Fryderyk Chopin Hospital in European Health Center Otwock, 05-400 Otwock, Poland
Marcin Kurzyna
Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, Fryderyk Chopin Hospital in European Health Center Otwock, 05-400 Otwock, Poland
We present a case of a 67-year-old female with proximal chronic thromboembolic pulmonary hypertension (CTEPH), disqualified from pulmonary endarterectomy due to multiple comorbidities and high risk-to-benefit ratio as assessed by multidisciplinary CTEPH team. She was referred for balloon pulmonary angioplasty (BPA) and underwent three sessions with balloon catheters up to 8 mm diameter. During the second procedure, the elastic recoil phenomenon was observed in the treated post-thrombotic lesion of the right lower lobe artery, which made the balloon angioplasty ineffective. It was decided to implant a self-expanding stent for the prevention of restenosis. The procedure resulted in significant improvement of regional perfusion, as confirmed by control angiography. We feel that it contributed to the significant improvement of hemodynamic parameters and exercise capacity, as assessed three months after the last BPA procedure. In conclusion, pulmonary artery stenting may be an option in proximal CTEPH when elastic recoil phenomenon makes balloon angioplasty of a large vessel ineffective.
