Organized thrombus in pulmonary arteries in patients with chronic thromboembolic pulmonary hypertension; imaging with cone beam computed tomography

Abstract

CBCT is found to be useful for the treatment planning of balloon pulmonary angioplasty distal to segmental arteries.

2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension

“…Although a mosaic pattern is frequent in CTEPH, it can also be observed in up to 12% of patients with PAH [425]. MR imaging of the pulmonary vasculature is still considered inferior to CT [426], but this modality, as well as cone beam CT [427], angioscopy [428], intravascular ultrasound or optical coherence tomography, may be complimentary and used according to local experience and practice.…”

Balloon pulmonary angioplasty: applicability of C-Arm CT for procedure guidance

“…information regarding the vessels surrounding structures, to the DSA work-up of CTEPH [18]. Contrast administration through a catheter placed in the pulmonary artery of interest results in a brilliant small-vessel depiction [18,19]. As shown in our study, the image information of CACT has the potential to support and guide BPA procedures.…”

“…Lesions assessable to BPA are mainly localized at the segmental and sub-segmental levels, typically involving bifurcation of the vascular branches [19]. During BPA, repeated selective angiograms with the catheter positioned directly proximal to a target lesion are required, potentially increasing the risk of vessel injury, especially close to bifurcations.…”

“…To avoid guidewire misplacement and balloon over-sizing, the majority of groups somehow uses guiding techniques to support the BPA procedures such as intra-vascular ultrasound, optical coherence tomography and pressure wires [11,16,17]. C-Arm computed tomography (CACT) is known to visualize peripheral CTEPH lesions in detail [18,19]. Therefore, guidance techniques using cross-sectional 3D imaging with high spatial resolution may be favourable to increase patient safety during BPA.…”

2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension

“…Chociaż obraz mozaiki jest częsty w CTEPH, to może on również występować u niemal 12% pacjentów z PAH [425]. Wciąż uważa się, że obrazowanie naczyń płucnych za pomocą MR jest gorsze od CT [426], ale badanie to można stosować zgodnie z lokalną praktyką i doświadczeniem, podobnie jak optyczną koherentną tomografię [427], ultrasonografię wewnątrznaczyniową lub angioskopię [428]. Cewnikowanie prawego serca jest podstawowym narzędziem diagnostycznym.…”