Related Experiment Video
Updated: Dec 7, 2025
Catheter-based Endovascular Angioplasty for Fibrosing Mediastinitis-associated Pulmonary Vein Stenosis
Published on: August 26, 2025
Novel Balloon Pulmonary Angioplasty Technique for Chronic Thromboembolic Pulmonary Hypertension
Shun Minatsuki1, Arihiro Kiyosue1, Satoshi Kodera1
1Department of Cardiovascular Medicine Graduate School of Medicine, The University of Tokyo.
Insights
The Ikari-curve left (IL) guiding catheter improves access to pulmonary arteries during balloon pulmonary angioplasty (BPA). This specialized catheter facilitates more successful vessel insertions and potentially reduces lung injury in patients with chronic thromboembolic pulmonary hypertension.
Area of Science:
- Cardiology
- Interventional Pulmonology
- Medical Devices
Background:
- Chronic thromboembolic pulmonary hypertension (CTEPH) treatment involves extensive pulmonary artery dilation.
- Guiding catheter shape is critical for accessing distal branches during balloon pulmonary angioplasty (BPA).
- Conventional guiding catheters face challenges in reaching specific target vessels in BPA procedures.
Purpose of the Study:
- To evaluate the effectiveness of the Ikari-curve left (IL) guiding catheter in BPA for CTEPH.
- To compare the IL guiding catheter's performance against conventional catheters regarding vessel access and safety.
- To determine if the IL catheter enhances the ability to treat more pulmonary artery branches.
Main Methods:
- Retrospective analysis of 202 BPA sessions (40 patients) from November 2016 to October 2019.
- Sessions were categorized into IL group (using IL guiding catheter) and non-IL group (using other catheters).
- Outcomes assessed included successful target vessel introduction and occurrence of lung injury (indicated by bloody sputum).
Main Results:
- The IL group treated a median of 15 branches per session versus 10 in the non-IL group (P < 0.05).
- Successful vessel insertions were significantly higher in the IL group (78.8%) compared to the non-IL group (42.7%) (P < 0.01).
- Lung injury occurred less frequently in the IL group (4.0%) than the non-IL group (11.7%), though not statistically significant (P = 0.07).
Conclusions:
- The IL guiding catheter demonstrates superior ability to access challenging pulmonary artery branches in BPA.
- Its use is associated with a higher number of treated vessels and a trend towards reduced lung injury.
- The IL catheter offers a valuable alternative for improving BPA efficacy in CTEPH management.
Abstract:
This study aimed to clarify the usefulness of the Ikari-curve left (IL) guiding catheter for balloon pulmonary angioplasty (BPA).The current BPA strategy for chronic thromboembolic pulmonary hypertension is dilation of as many branches as possible to normalize hemodynamics and oxygenation. The shape of the guiding catheter is a major factor in achieving this. However, conventional guiding catheters are difficult to introduce into particular branches. The IL guiding catheter may be suitable; however, its utility remains unclear.We retrospectively analyzed 202 consecutive BPA sessions of 40 patients from November 2016 to October 2019 and divided these sessions into two groups: the IL group where the IL guiding catheter was used and the non-IL group where other catheters were utilized. The occurrence of lung injury was determined by the presence of bloody sputum. We compared the rates of successful introduction into target vessels and assessed for the occurrence of lung injury.The average age of enrolled patients was 60.3 ± 14.4 years, with females comprising 65%. There were 99 sessions in the IL group. The median treated branches per session differed between the 2 groups (IL group: 15 versus non-IL group: 10, P < 0.05). The occurrence of lung injury was lower in the IL group (4.0% versus 11.7%, P = 0.07). The IL group had more successful vessel insertions than the non-IL group (78.8% versus 42.7%, P < 0.01).The IL guiding catheter may be introduced into branches that cannot be accessed by conventional guiding catheters.
Related Concept Videos
01:29Pulmonary Embolism II: Diagnostic Studies and Interprofessional Care
01:27Peripheral Artery Disease III: Interprofessional Care
01:29Venous Thrombosis III: Interprofessional Care
01:27Pulmonary Embolism III: Nursing Management
01:23Treatment for Pulmonary Arterial Hypertension: Prostacyclin Receptor Agonists
These agonists bind to the IPR receptor situated on the plasma membrane of the pulmonary artery smooth muscle cells. This binding triggers a cascade of reactions known as the GS-AC-cAMP-PKA pathway. This pathway results in the relaxation of smooth muscle...