Evaluation of organized thrombus in distal pulmonary arteries in patients with chronic thromboembolic pulmonary hypertension using cone-beam computed tomography

Fukuda, Tsuyoshi; Ogo, Takeshi; Nakanishi, Norifumi; Ueda, Jin; Sanda, Yoshihiro; Morita, Yoshiaki; Sugiyama, Munehiro; Fukui, Shigefumi; Tsuji, Akiko; Naito, Hiroyuki

doi:10.1007/s11604-016-0538-2

Cited by 31 publications

(16 citation statements)

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“…Type 1a: webs; type 1b: webs with severe narrowing of the subsegmental artery; type 2: web and slits; type 3: slits; and type 4: pouch defect with incomplete obstruction of subsegmental branches or complete occlusion. >90% of lesions diagnosed by CBCT were consistent with the findings on selective angiography during BPA [57].…”

Section: Imaging For Bpasupporting

confidence: 71%

“…Cone-beam computed tomography (CBCT) is important for localisation of relevant intra-arterial lesions and the assessment of pulmonary artery diameter. A recent study by FUKUDA et al [57] comparing CBCT with selective angiography during BPA has shown that CBCT can be used to select target lesions in segmental and subsegmental pulmonary artery branches, and gives clearer images of webs and bands than conventional computed tomography angiography. They identified the following lesion types.…”

Section: Imaging For Bpamentioning

confidence: 99%

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Balloon pulmonary angioplasty in chronic thromboembolic pulmonary hypertension

et al. 2017

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Chronic thromboembolic pulmonary hypertension (CTEPH) is thought to result from incomplete resolution of pulmonary thromboemboli that undergo organisation into fibrous tissue within pulmonary arterial branches, filling pulmonary arterial lumina with collagenous obstructions. The treatment of choice is pulmonary endarterectomy (PEA) in CTEPH centres, which has low post-operative mortality and good long-term survival. For patients ineligible for PEA or who have recurrent or persistent pulmonary hypertension after surgery, medical treatment with riociguat is beneficial. In addition, percutaneous balloon pulmonary angioplasty (BPA) is an emerging option, and promises haemodynamic and functional benefits for inoperable patients. In contrast to conventional angioplasty, BPA with undersized balloons over guide wires exclusively breaks intraluminal webs and bands, without dissecting medial vessel layers, and repeat sessions are generally required. Observational studies report that BPA improves haemodynamics, symptoms and functional capacity in patients with CTEPH, but controlled trials with long-term follow-up are needed. Complications include haemoptysis, wire injury, vessel dissection, vessel rupture, reperfusion pulmonary oedema, pulmonary parenchymal bleeding and haemorrhagic pleural effusions. This review summarises the available evidence for BPA, patient selection, recent technical refinements and periprocedural imaging, and discusses the potential future role of BPA in the management of CTEPH.

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Section: Imaging For Bpasupporting

confidence: 71%

Section: Imaging For Bpamentioning

confidence: 99%

Balloon pulmonary angioplasty in chronic thromboembolic pulmonary hypertension

et al. 2017

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“…Magnetic resonance imaging of the pulmonary vasculature is still considered inferior to CT [457]. Cone-beam CT [458], angioscopy [459], intravascular ultrasound, and optical coherence tomography are more suitable for the characterization of lesions during interventional treatment than for diagnosis. High-resolution CT scan of the chest may assist in the differential diagnosis of CTEPH, showing emphysema, bronchial, or interstitial lung disease, as well as infarcts, and vascular and thoracic wall malformations.…”

Section: Clinical Presentation and Diagnosismentioning

confidence: 99%

2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS)

et al. 2019

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“…Image merging produces a three-dimensional roadmap that can be used in conjunction with real-time fluoroscopy, and provides the possibility of live monitoring from any angle and magnification. This can provide invaluable guidance for complex pulmonary vascular interventions [48][49][50].…”

Section: Rotational Angiography and Cone Beam Ctmentioning

confidence: 99%

Diagnosis of chronic thromboembolic pulmonary hypertension

Delcroix²,

2017

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Chronic thromboembolic pulmonary hypertension (CTEPH) is the only potentially curable form of pulmonary hypertension. Rapid and accurate diagnosis is pivotal for successful treatment. Clinical signs and symptoms can be nonspecific and risk factors such as history of venous thromboembolism may not always be present. Echocardiography is the recommended first diagnostic step. Cardiopulmonary exercise testing is a complementary tool that can help to identify patients with milder abnormalities and chronic thromboembolic disease, triggering the need for further investigation. Ventilation/perfusion ('/') scintigraphy is the imaging methodology of choice to exclude CTEPH. Single photon emission computed tomography '/' is gaining popularity over planar imaging. Assessment of pulmonary haemodynamics by right heart catheterisation is mandatory, although there is increasing interest in noninvasive haemodynamic evaluation. Despite the status of digital subtraction angiography as the gold standard, techniques such as computed tomography (CT) and magnetic resonance imaging are increasingly used for characterising the pulmonary vasculature and assessment of operability. Promising new tools include dual-energy CT, combination of rotational angiography and cone beam CT, and positron emission tomography. These innovative procedures not only minimise misdiagnosis, but also provide additional vascular information relevant to treatment planning. Further research is needed to determine how these modalities will fit into the diagnostic algorithm for CTEPH.

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Evaluation of organized thrombus in distal pulmonary arteries in patients with chronic thromboembolic pulmonary hypertension using cone-beam computed tomography

Abstract: CBCT clearly revealed and classified distal lesions in CTEPH patients. The CBCT findings for distal lesions were highly consistent with those of selective angiography during BPA. CBCT could be a useful modality to detect target lesions before BPA.

Cited by 31 publications

References 13 publications

Balloon pulmonary angioplasty in chronic thromboembolic pulmonary hypertension

Balloon pulmonary angioplasty in chronic thromboembolic pulmonary hypertension

2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS)

Diagnosis of chronic thromboembolic pulmonary hypertension

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