Darocha Szymon, Pietura Radosław, Banaszkiewicz Marta, Pietrasik Arkadiusz, Kownacki Łukasz, Torbicki Adam, Kurzyna Marcin
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.
Department of Radiography, Medical University of Lublin, 20-081 Lublin, Poland.
Diagnostics (Basel). 2020 Jun 1;10(6):363. doi: 10.3390/diagnostics10060363.
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.
我们报告一例67岁女性近端慢性血栓栓塞性肺动脉高压（CTEPH）患者，由于存在多种合并症且多学科CTEPH团队评估其风险效益比高，不适合行肺动脉内膜剥脱术。她被转诊接受球囊肺动脉血管成形术（BPA），并使用直径达8mm的球囊导管进行了三次手术。在第二次手术过程中，在右下叶动脉血栓形成后的病变部位观察到弹性回缩现象，这使得球囊血管成形术无效。于是决定植入自膨式支架以预防再狭窄。该手术使局部灌注得到显著改善，对照血管造影证实了这一点。我们认为，这有助于显著改善血流动力学参数和运动能力，这是在最后一次BPA手术后三个月评估得出的结论。总之，当弹性回缩现象导致大血管球囊血管成形术无效时，肺动脉支架置入术可能是近端CTEPH的一种选择。
