Percutaneous implantation of a balloon-expandable endoprosthesis for pulmonary artery stenosis: an experimental study

Conventional therapy to treat peripheral pulmonary artery stenosis (surgery or balloon angioplasty) has been frustrating. Recently a variety of peripheral vascular stenoses, in which conventional approaches are disappointing, have become amenable to therapy with the use of a balloon-expandable endovascular stent. This experimental study was designed to assess the application of such a prosthesis in artificially created pulmonary artery stenoses. In 9 of 12 2-week old pigs, left pulmonary artery stenosis was surgically created (3.9 +/- 1.1 mm diameter and 7 +/- 1 mm Hg mean gradient). At 6.8 +/- 1 weeks of age (13 +/- 4 kg), percutaneous (femoral venous) implantation of a 3-cm long balloon-expandable (maximal diameter 18 mm) stent (three placed into normal pulmonary artery branches) using a 3-cm x 10-mm balloon dilating catheter was achieved without technical difficulties. Stenoses were enlarged to 8.3 +/- 1.4 mm with a decrease in mean gradient to 1 +/- 1 mm Hg that was maintained through 3.5 months of follow-up. Histologic and electron micrographic studies identified normal-appearing neoendothelial layering over stent struts without intraluminal or peripheral thrombus formation and nonobstructed side branching to lung subsegments. These findings support the application of this approach in the treatment of pulmonary stenosis that is not amenable to conventional therapy.