Retrograde Recanalization of Occluded Pulmonary Arteries via Percutaneous Transluminal Pulmonary Angioplasty

Complete occlusion of pulmonary artery branches is challenging for percutaneous transluminal pulmonary angioplasty (PTPA) in chronic thromboembolic pulmonary hypertension (CTEPH) patients.

We report 2 CTEPH patients (a 30-year-old woman and a 63-year-old woman) with complete occlusion of right A8a and left A7 branches, respectively. In case 1, a Sion guidewire was advanced retrogradely via an intrapulmonary collateral from the adjacent A8b branch, successfully crossing the occlusion followed by balloon dilation. In case 2, the retrograde wire could not re-enter the proximal trunk; it was left as an intraluminal landmark to guide an antegrade Pilot 50 wire, achieving recanalization. Both cases were technically successful without complications.

Retrograde wiring via intrapulmonary collaterals is feasible and can facilitate recanalization of occluded pulmonary arteries during PTPA.

In selected CTEPH patients, intrapulmonary collaterals provide a retrograde route to recanalize occluded pulmonary arteries during PTPA.