Rescue Implantation of Covered Stent in Pulmonary Artery Rupture During Balloon Pulmonary Angioplasty

J INVASIVE CARDIOL 2018;30(11):E122-E123.

Key words: cardiac imaging, computed tomography, covered stent

A 62-year-old female with residual pulmonary hypertension after pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension (CTEPH) underwent balloon pulmonary angioplasty (BPA). At baseline, she was in functional class III and mean pulmonary artery pressure was 50 mm Hg. BPA was performed as a staged procedure; at the third BPA session, we targeted the left subsegmental A9a artery. Selective pulmonary angiography showed the ring-like lesion (Figure 1A). Subsequently, we dilated the lesion with a 5.0 x 20 mm Viatrac balloon (Abbott Vascular) (Figure 1B). However, immediately after deflation of the balloon, severe hemosputum and cough occurred. Pulmonary angiography showed extravasation of contrast medium (Figure 1C; Video 1) and pulmonary artery rupture and dissection were recognized. A 3.0 x 20 mm Jostent GraftMaster covered stent (Abbott Vascular) was implanted to the rupture site (Figure 1D). Control angiography revealed the disappearance of extravasation of contrast medium (Figure 1E; Video 2). Pulmonary computed tomography angiography performed 12 months later showed no signs of in-stent restenosis and patency of the vessel (Figures 1F, 1G). Three-dimensional reconstruction of the computed tomography pulmonary angiography is shown in Figure 1H.

The ring-like lesions in CTEPH patients are sometimes difficult to dilate because they are hard and fibrotic. For this reason, slightly oversized balloons are used. However, this may result in an increased risk of vessel rupture. Implantation of a covered stent not only protects the ruptured vessel, but also maintains perfusion in the future.

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From the ¹1st Department of Cardiology and ²Department of Radiology, University of Medical Sciences, Poznan, Poland.

Disclosure: The authors have completed and returned the ICMJE Form for Disclosure of Potential Conflicts of Interest. The authors report no conflicts of interest regarding the content herein.

Manuscript accepted May 17, 2018. 

Address for correspondence: Aleksander Araszkiewicz, MD, PhD, 1st Department of Cardiology, Poznan University of Medical Sciences, Dluga1/2, 61-848 Poznan, Poland. Email: aaraszkiewicz@interia.pl