Author + information
- Received July 29, 2016
- Accepted August 11, 2016
- Published online November 14, 2016.
- Koshin Horimoto, MDa,
- Kohtaro Abe, MD, PhDa,∗ (, )
- Kisho Ohtani, MD, PhDa,
- Yusuke Takahara, MDa,
- Kazuya Hosokawa, MD, PhDa,
- Keiji Oi, MD, PhDa,
- Yasushi Mukai, MD, PhDa,
- Takashi Kubo, MD, PhDb,
- Tetsuya Matoba, MD, PhDa and
- Hiroyuki Tsutsui, MD, PhDa
- aDepartment of Cardiovascular Medicine, Kyushu University Hospital, Fukuoka, Japan
- bDepartment of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
- ↵∗Reprint requests and correspondence:
Dr. Kohtaro Abe, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
- balloon pulmonary angioplasty
- chronic thromboembolic pulmonary hypertension
- covered stent
A 60-year-old man with inoperable chronic thromboembolic pulmonary hypertension was referred to our hospital for balloon pulmonary angioplasty (BPA). Four series of BPA dramatically improved pulmonary hypertension: mean pulmonary arterial pressure from 42 to 29 mm Hg and cardiac index from 1.9 to 2.5 l/min/m2. However, during the last BPA to a residual lesion (right #9), vessel rupture and aneurysmal formation occurred (Figure 1A). We implanted a covered stent (GRAFTMASTER RX, Abbott Vascular, Santa Clara, California) to seal the orifice of the pseudoaneurysm and then added aspirin to warfarin. A follow-up (18-month) pulmonary angiography showed the patency with 50% diameter stenosis of the stent (Figure 1B). Optical frequency domain imaging (OFDI) (TERUMO Co., Tokyo, Japan) also demonstrated the high-intensity concentric neointimal layer in the stent with little thrombus (Figure 1C, Online Video 1). The covered stent was reported to be useful as a bailout tool for pulmonary artery rupture associated with BPA (1). However, its structural characteristics and long-term patency remain unknown. Our case suggested that neointimal hyperplasia might largely contribute to the in-stent stenosis in the pulmonary as well as coronary arteries (2).
For a supplemental video and legend, please see the online version of this article.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received July 29, 2016.
- Accepted August 11, 2016.
- American College of Cardiology Foundation