Case report of successfull application of optical coherent tomography as differential diagnostic modality of the false-positive angiographic thrombotic signs in diagnostic and endovascular treatment of chronic thromboembolic pulmonary hypertension
Nowadays percutaneous balloon pulmonary angioplasty (BPA) is one of the most promising and emerging treatment options in patients with chronic thromboembolic pulmonary hypertension (CTEPH). However, one of the key features of successful BPA in patients with CTEPH is possibility of accurate assessment of diseased segments of pulmonary artery (PA). Patient, 53 y.o., got admitted to Bakoulev National Medical Research Center for Cardiovascular Surgery for surgical treatment. Clinical examinations revealed CTEPH with PA obstruction in distal branches of the right and left lung. Due to distal localization of thrombi and patients clinical condition we decided to perform staged BPA of median and small calibre PA branches where we registered thrombi presence on both angiography and optical coherent tomography (OCT). An angiographic sign showed a concentric narrowing in the ostia of the inferior right lower segmental pulmonary artery, however, according to OCT, the lumen of the PA was normal, without thrombotic overlap. At this moment, we decided to perform the BPA in the upper segment of the left PA with the confirmed presence of thrombi on OCT with a good angiographic result. BPA in patients with CTEPH, controlled with intravascular visualization, can significantly improve positive result of this procedure and overall clinical status in these patients.