Bifurcating stents in the pulmonary arteries: A novel technique to relieve bilateral branch pulmonary artery obstruction

Abstract

Balloon angioplasty and stent placement in close proximity to the bifurcation of the branch pulmonary arteries can be challenging. Multiple approaches have been previously described, though none of these approaches both treats bilateral proximal branch pulmonary artery stenosis and provides an anchor for a transcatheter pulmonary valve replacement. We report a novel approach that involves serial stent placement and balloon dilation through the struts of the stent in each pulmonary artery, along with balloon expansion of the proximal portion of the stents to the diameter of the main pulmonary artery. In the two cases we describe, this strategy resulted in significant relief of branch pulmonary artery obstruction without compromising the anatomy of the main pulmonary artery segment. This technique can be an effective way to alleviate stenoses of the bilateral proximal branch pulmonary arteries and provide a landing zone for a future transcatheter pulmonary valve.

Treatment of Inferior Vena Cava Obstruction Following Pediatric Liver Transplantation: Novel Use of a Customized Endovascular Stent

“…This technique was recently described in patients with congenital heart disease for treatment of complex bifurcation lesions, such as distal right ventricle-to-pulmonary artery conduit stenosis with bilateral proximal branch pulmonary artery stenosis. 17 The approach has been rapidly adopted by the pediatric interventional cardiology community, because it facilitates ideal treatment of a lesion that previously required open heart surgery or received inadequate relief of stenosis with standard transcatheter approaches. To date, this technique has not been widely used within the pediatric or adult interventional radiology communities and thus might not be considered when approaching the typical post-liver transplantation caval obstruction lesion.…”

Let it flow

“…• Drug eluting (Resonance GmbH, Aachen, Germ) 9.3 (29) • Dorado (Bard Peripheral Vascular inc, Tempe, USA) 8.3 (26) • Cutting balloon (various) 3.2 (10) • Tyshak (NuMED Inc, NY, USA) 1.6 (5) N: number of patients, y: yes, MPA: main pulmonary artery, RPA: right pulmonary artery, LPA: left pulmonary artery. • AndraStent XXL (Andramed GmbH, Reutlingen, Germ) 5.4 (27) • BeGraft (Bentley, Hechingen, Germ) 3.8 (19) • Coronary stent (various) 2.6 (13) • Cordis Palmaz Genesis (CardinalHealth, Dublin, Ireland) 2.2 (11) • Atrium Advanta V12 (Getinge AB, Gotenborg, Sweden) 0.8 (4)…”

“…These 19 studies described the use of CFD in surgical planning, for comparison of different shunt configurations or to study (post)-surgical complications. [13][14][15][16][18][19][20][21][22][23][24][25][26][27][28][29][30][31] In two papers numerical studies were used to evaluate interventional strategies. 32,33 One of these described a CFD-assisted patient-specific stent design for PA interventions and the other studied a new device for percutaneous pulmonary valve replacement.…”

“…13,21,22,25,[27][28][29][30]43 The other 21 studies were published in technical journals, for example, focusing on biomedical engineering or numerical methods in medicine. 12,14,15,17,19,23,26,[31][32][33][34][35][36][37][38][39][40][41][42]44 In the following sections, the various used methods for numerical analysis of the PA's will be compared. The sections are subdivided into the major steps necessary for solving a CFD case.…”

“…The source for this reconstruction was a cardiac CT in 16 studies and CMR in six studies. 18,20,21,23,25,26,[30][31][32][35][36][37][42][43][44][45] , 12,33,34,[39][40][41] In the remaining two studies, multiple plane measurements on cardiac angiography were taken after which the anatomy was reconstructed. 16,27 For surgical studies, often one patient-specific anatomy was created after which the anatomy was altered to mimic various surgical approaches.…”