Abstract 14814: Angioscopic Evalutation of Organized Thrombus in Chronic Thromboembolic Pulmonary Hypertension During Balloon Pulmonary Angioplasty
Background: Balloon pulmonary angioplasty (BPA) has been reported to be an effective treatment for inoperable patients with chronic thromboembolic pulmonary hypertension (CTEPH). Assessment of how the pathological morphology during BPA contributes to an improvement of procedural outcomes may provide new knowledge about the progression of this disorder.
Methods: We retrospectively assessed the pathological morphology of organized thrombi observed by angioscopy in 28 lesions from 9 CTEPH patients, in whom angioscopy-guided BPA was performed.
Results: The median age was 66 years old and 78 % of the patients were female. Mean pulmonary artery pressure at diagnosis was 38±3 mmHg, mean right atrium pressure 8±1 mmHg, cardiac output 4.0±0.4 L/min, and pulmonary vascular resistance 8.1±1.5 Wood units. By angioscopy, web lesions on angiography were revealed as net-like ramified white thrombi, and ring-like stenosis was observed as a hard mass thrombus. Abrupt vascular narrowing lesions appeared as either net-like or flap thrombi by angioscopy. All complete vascular obstruction lesions were formed by flap thrombi. Most vessels had distal thrombus lesions that were difficult to detect by contrast angiography or intravascular ultrasonography. After
balloon dilatation, angioscopy revealed hemorrhaging from the vascular wall due to injury from the BPA procedure.
Conclusions: Angioscopy allows for the detailed evaluation of lesions that were difficult to identify by angiography or intravascular ultrasonography, and reveals vascular injuries incurred by the BPA procedure. The assessment of lesion morphology and vascular injuries using angioscopy might contribute to the safe and effective BPA.
Author Disclosures: H. Tsubata: None. N. Nakanishi: None. K. Fukai: None. K. Zen: None. T. Nakamura: None. T. Yamano: None. H. Shiraishi: None. T. Shirayama: None. S. Matoba: None.
- © 2016 by American Heart Association, Inc.