Pulmonary Angioplasty in Chronic Thromboembolic Pulmonary Hypertension. Are Intravascular Ultrasound and Stents Helpful?

Pulmonary arterial angioplasty (PA) in chronic thromboembolic pulmonary hypertension (CTEPH) is an option for patients rejected for surgical pulmonary endarterectomy. Preliminary results seem encouraging, although pulmonary injure rates are reported. 11 patients (6 woman) with CTEPH, mean age 64 16 underwent PA. Four patients were in functional class 3, mean TAPSE was 15 4mm. Before the procedure, mean pulmonary pressure (mPAP) was 49 13mmHg, all had normal left ventricular ejection fraction and were under a chronic anticoagulant therapy. 10 out of 11 patients were done under intravascular ultrasound (IVUS) guidance in order to precisely estimate the vessel size. 20 stents were delivered to correct severe initial recoil or arterial occlusive dissection after initial balloon dilatation. There were no procedural complications (no regional pulmonary edema, no pulmonary vessel rupture). On follow-up (16.5 6,4 months), we observed improvement in functional class in 9 out of the 11 patients. No hospital admission and no dead were seen on follow-up. Pulmonary angioplasty under IVUS guidance seems to improve the procedure safety in our series, probably avoiding vessel rupture due to a more precise vessel sizing. Stent implantation seems to be safe and has no restenosis.