Successful depiction of systemic collateral supply to pulmonary artery in CTEPH using time-resolved 4D CT...

Area of Science:

• Cardiovascular Imaging
• Interventional Radiology

Background:

• Chronic thromboembolic pulmonary hypertension (CTEPH) presents challenges in treatment, particularly with chronic total occlusions in pulmonary arteries.
• Accurate pre-procedural assessment of collateral circulation is crucial for successful interventions like balloon pulmonary angioplasty (BPA).

Observation:

• A 49-year-old male patient with CTEPH (mean pulmonary artery pressure: 36 mmHg) underwent BPA for a chronic total occlusion of the left inferior pulmonary artery trunk.
• Four-dimensional computed tomography angiography (4D-CTA) using a 256-row detector CT system was employed to evaluate collateral vessels.

Findings:

• 4D-CTA successfully identified bronchial artery-to-left inferior pulmonary artery collateral supply, which was subsequently confirmed by selective bronchial artery angiography.
• The patient experienced symptom improvement following BPA of other stenotic lesions.

Implications:

• 4D-CTA offers a noninvasive method to simultaneously assess the anatomy and hemodynamics of multiple systemic collateral pathways.
• This technique can aid in planning and executing interventions for systemic artery-to-pulmonary artery collaterals, including embolization.
• 4D-CTA is valuable in complex BPA for chronic total occlusions, enabling identification of distal vessel structures and collateral channels for retrograde approaches.