2017 Volume 58 Issue 5 Pages 824-827
A pouching defect, which is a type of angiographic classification in chronic thromboembolic pulmonary hypertension (CTEPH), is equivalent to a chronic total occlusion (CTO). Thus far, treating CTO involves high risk of the lung bleeding and is difficult because the structure and treating strategy have not been clarified, yet treating it has great potential to improve hemodynamic status and ventilation perfusion mismatch. Here, we describe a case of successfully treated the CTO. In this case, we treated it safely by two balloon pulmonary angiography (BPA) sessions. In first session, the surface of the CTO was partially broken by the catheter. However, the distal vessels of it were not observed. Pulmonary angiogram was performed 4 months later, the distal vessels of CTO were observed. This lesion was no longer the CTO, we performed BPA safely and pulmonary arterial pressure was improved dramatically. Furthermore, pulmonary angiogram revealed the surface of the CTO has a cap which is comprised of cross-aggregation of organized thrombi. Partial breakage of the cap is a key to recanalization of the CTO, even if the distal vessels were not seen in same BPA session.
