Safety Window for Effective Lesion Crossing in Patients With Chronic Thromboembolic Pulmonary Hypertension

Authors

Sidney J. Perkins
Miguel Funes
Daniel Cheah
Christian Argenti
Jorge Vinales
David Gordon
Jonathan W. Haft
David M. Williams
Vallerie V. Mclaughlin
Prachi P. Agarwal
Victor M. Moles
Thomas Cascino
Andrea Obi
Aditya Pandey
Albert Shih
Vikas Aggarwal, Henry Ford HealthFollow

Recommended Citation

Perkins SJ, Funes M, Cheah D, Argenti C, Vinales J, Gordon D, Haft JW, Williams DM, McLaughlin VV, Agarwal PP, Moles VM, Cascino T, Obi A, Pandey A, Shih A, and Aggarwal V. Safety Window for Effective Lesion Crossing in Patients With Chronic Thromboembolic Pulmonary Hypertension. J Soc Cardiovasc Angiogr Interv 2024; 3(8):102142.

Document Type

Article

Publication Date

8-1-2024

Publication Title

J Soc Cardiovasc Angiogr Interv

Abstract

BACKGROUND: Balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension (CTEPH) is limited by a lack of safe and effective tools for crossing these lesions. We aim to identify a safety window for an intraluminal crossing device in this vascular bed by studying the piercing properties of pulmonary arterial vessel walls and intraluminal CTEPH lesion specimens. As a secondary objective, we also describe the histopathologic features of CTEPH lesions.

METHODS: Specimens were procured from 9 patients undergoing pulmonary endarterectomy. The specimens were subsampled and identified grossly as arterial wall or intraluminal CTEPH lesions. The force needed for tissue penetration was measured using a 0.38-mm (0.015-in) diameter probe in an ex vivo experimental model developed in our lab. Concurrent histology was also performed.

RESULTS: The mean force needed to penetrate the arterial wall and intraluminal CTEPH lesions was 1.75 ± 0.10 N (n = 121) and 0.30 ± 0.04 N (n = 56), respectively (P < .001). Histology confirmed the presence of intimal hyperplasia with calcium and hemosiderin deposition in the arterial wall as well as an old, organized thrombus in the lumen.

CONCLUSIONS: The pulmonary arterial wall is friable and prone to perforation during instrumentation with workhorse coronary guide wires. However, the results of this study demonstrate that a much lower force is needed for the 0.38-mm (0.015-in) probe to penetrate an intraluminal CTEPH lesion compared to pulmonary arterial intima. This finding suggests the existence of a safety window for lesion-crossing devices, enabling effective balloon pulmonary angioplasty.

PubMed ID

39166161

Volume

3

Issue

8

First Page

102142

Last Page

102142