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Erschienen in: European Radiology 11/2016

23.02.2016 | Interventional

Balloon pulmonary angioplasty: applicability of C-Arm CT for procedure guidance

verfasst von: Jan B. Hinrichs, Julius Renne, Marius M. Hoeper, Karen M. Olsson, Frank K. Wacker, Bernhard C. Meyer

Erschienen in: European Radiology | Ausgabe 11/2016

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Abstract

Purpose

To investigate the feasibility of and compare two C-Arm CT (CACT) guidance methods during balloon pulmonary angioplasty (BPA).

Material and methods

Forty-two BPAs [27 CTEPH patients (nine males, 70 ± 14y)] targeting 143 pulmonary arteries were included. Twenty-two BPAs were guided by contrast-enhanced CACT acquired immediately before BPA (G3D). In another 20 BPAs (G2D), two orthogonal fluoroscopy images of the chest where acquired to compute a registration of a previously acquired CACT. Volume rendering-based graphic representations (VRT guidance) were generated indicating the origin and course of the vessels. Based on VRT guidance, the intervention was planned. Procedure durations and radiation exposure data were compared between the two groups (Wilcoxon test).

Results

The overall intervention time was approximately 2 h in both groups (p = 0.31). BPA was successfully performed in G3D 91 % and G2D 94 %. No significant difference was found concerning the mean dose area product (DAP) related to fluoroscopy (p = 0.38), while DAP related to DSA was slightly higher in G3D (p = 0.048). Overall, DAP was significantly higher in G3D (p = 0.002).

Conclusions

The use of CACT for procedure guidance in patients undergoing BPA is feasible and accurate. Image fusion of a pre-acquired CACT can be used to decrease radiation exposure due to multiple BPA sessions.

Key Points

BPA guidance by CACT overlay is feasible and safe.
2D3D image fusion for BPA guidance is accurate.
Image fusion can reduce patient radiation dose due to repeated BPA sessions.
Literatur
1.
Zurück zum Zitat Kim NH, Delcroix M, Jenkins DP et al (2013) Chronic thromboembolic pulmonary hypertension. J Am Coll Cardiol 62:D92–D99CrossRefPubMed Kim NH, Delcroix M, Jenkins DP et al (2013) Chronic thromboembolic pulmonary hypertension. J Am Coll Cardiol 62:D92–D99CrossRefPubMed
2.
Zurück zum Zitat Hoeper MM, Madani MM, Nakanishi N et al (2014) Chronic thromboembolic pulmonary hypertension. Lancet Respir Med 2:573–582CrossRefPubMed Hoeper MM, Madani MM, Nakanishi N et al (2014) Chronic thromboembolic pulmonary hypertension. Lancet Respir Med 2:573–582CrossRefPubMed
3.
4.
Zurück zum Zitat Tanabe N, Sugiura T, Tatsumi K (2013) Recent progress in the diagnosis and management of chronic thromboembolic pulmonary hypertension. Respir Investig 51:134–146CrossRefPubMed Tanabe N, Sugiura T, Tatsumi K (2013) Recent progress in the diagnosis and management of chronic thromboembolic pulmonary hypertension. Respir Investig 51:134–146CrossRefPubMed
5.
Zurück zum Zitat Pengo V, Lensing AWA, Prins MH et al (2004) Incidence of chronic thromboembolic pulmonary hypertension after pulmonary embolism. N Engl J Med 350:2257–2264CrossRefPubMed Pengo V, Lensing AWA, Prins MH et al (2004) Incidence of chronic thromboembolic pulmonary hypertension after pulmonary embolism. N Engl J Med 350:2257–2264CrossRefPubMed
6.
Zurück zum Zitat Jenkins D, Mayer E (2012) State-of-the-art chronic thromboembolic pulmonary hypertension diagnosis and management. Eur Respir Rev 21:32–39CrossRefPubMed Jenkins D, Mayer E (2012) State-of-the-art chronic thromboembolic pulmonary hypertension diagnosis and management. Eur Respir Rev 21:32–39CrossRefPubMed
7.
Zurück zum Zitat Mayer E (2010) Surgical and post-operative treatment of chronic thromboembolic pulmonary hypertension. Eur Respir Rev 19:64–67CrossRefPubMed Mayer E (2010) Surgical and post-operative treatment of chronic thromboembolic pulmonary hypertension. Eur Respir Rev 19:64–67CrossRefPubMed
8.
Zurück zum Zitat Piazza G, Goldhaber SZ (2011) Chronic thromboembolic pulmonary hypertension. N Engl J Med 364:351–360CrossRefPubMed Piazza G, Goldhaber SZ (2011) Chronic thromboembolic pulmonary hypertension. N Engl J Med 364:351–360CrossRefPubMed
9.
Zurück zum Zitat Pepke-Zaba J, Jansa P, Kim NH et al (2013) Chronic thromboembolic pulmonary hypertension: role of medical therapy. Eur Respir J 41:985–990CrossRefPubMed Pepke-Zaba J, Jansa P, Kim NH et al (2013) Chronic thromboembolic pulmonary hypertension: role of medical therapy. Eur Respir J 41:985–990CrossRefPubMed
10.
Zurück zum Zitat Kataoka M, Inami T, Hayashida K et al (2012) Percutaneous transluminal pulmonary angioplasty for the treatment of chronic thromboembolic pulmonary hypertension. Circ Cardiovasc Interv 5:756–762CrossRefPubMed Kataoka M, Inami T, Hayashida K et al (2012) Percutaneous transluminal pulmonary angioplasty for the treatment of chronic thromboembolic pulmonary hypertension. Circ Cardiovasc Interv 5:756–762CrossRefPubMed
11.
Zurück zum Zitat Mizoguchi H, Ogawa A, Munemasa M et al (2012) Refined balloon pulmonary angioplasty for inoperable patients with chronic thromboembolic pulmonary hypertension. Circ Cardiovasc Interv 5:748–755CrossRefPubMed Mizoguchi H, Ogawa A, Munemasa M et al (2012) Refined balloon pulmonary angioplasty for inoperable patients with chronic thromboembolic pulmonary hypertension. Circ Cardiovasc Interv 5:748–755CrossRefPubMed
12.
Zurück zum Zitat Andreassen AK, Ragnarsson A, Gude E et al (2013) Balloon pulmonary angioplasty in patients with inoperable chronic thromboembolic pulmonary hypertension. Heart 99:1415–1420CrossRefPubMed Andreassen AK, Ragnarsson A, Gude E et al (2013) Balloon pulmonary angioplasty in patients with inoperable chronic thromboembolic pulmonary hypertension. Heart 99:1415–1420CrossRefPubMed
13.
Zurück zum Zitat Yanagisawa R, Kataoka M, Inami T et al (2014) Safety and efficacy of percutaneous transluminal pulmonary angioplasty in elderly patients. Int J Cardiol 175:285–289CrossRefPubMed Yanagisawa R, Kataoka M, Inami T et al (2014) Safety and efficacy of percutaneous transluminal pulmonary angioplasty in elderly patients. Int J Cardiol 175:285–289CrossRefPubMed
14.
Zurück zum Zitat Inami T, Kataoka M, Ando M et al (2014) A new era of therapeutic strategies for chronic thromboembolic pulmonary hypertension by two different interventional therapies; pulmonary endarterectomy and percutaneous transluminal pulmonary angioplasty. PLoS ONE 9:e94587CrossRefPubMedPubMedCentral Inami T, Kataoka M, Ando M et al (2014) A new era of therapeutic strategies for chronic thromboembolic pulmonary hypertension by two different interventional therapies; pulmonary endarterectomy and percutaneous transluminal pulmonary angioplasty. PLoS ONE 9:e94587CrossRefPubMedPubMedCentral
15.
Zurück zum Zitat Sugimura K, Fukumoto Y, Satoh K et al (2012) Percutaneous transluminal pulmonary angioplasty markedly improves pulmonary hemodynamics and long-term prognosis in patients with chronic thromboembolic pulmonary hypertension. Circ J 76:485–488CrossRefPubMed Sugimura K, Fukumoto Y, Satoh K et al (2012) Percutaneous transluminal pulmonary angioplasty markedly improves pulmonary hemodynamics and long-term prognosis in patients with chronic thromboembolic pulmonary hypertension. Circ J 76:485–488CrossRefPubMed
16.
Zurück zum Zitat Inami T, Kataoka M, Shimura N et al (2014) Pressure-wire-guided percutaneous transluminal pulmonary angioplasty: a breakthrough in catheter-interventional therapy for chronic thromboembolic pulmonary hypertension. JACC Cardiovasc Interv 7:1297–1306CrossRefPubMed Inami T, Kataoka M, Shimura N et al (2014) Pressure-wire-guided percutaneous transluminal pulmonary angioplasty: a breakthrough in catheter-interventional therapy for chronic thromboembolic pulmonary hypertension. JACC Cardiovasc Interv 7:1297–1306CrossRefPubMed
18.
Zurück zum Zitat Hinrichs JB, Marquardt S, von Falck C et al (2016) Comparison of C-arm computed tomography and digital subtraction angiography in patients with chronic thromboembolic pulmonary hypertension. Cardiovasc Intervent Radiol 39:53–63CrossRefPubMed Hinrichs JB, Marquardt S, von Falck C et al (2016) Comparison of C-arm computed tomography and digital subtraction angiography in patients with chronic thromboembolic pulmonary hypertension. Cardiovasc Intervent Radiol 39:53–63CrossRefPubMed
19.
Zurück zum Zitat Sugiyama M, Fukuda T, Sanda Y et al (2014) Organized thrombus in pulmonary arteries in patients with chronic thromboembolic pulmonary hypertension; imaging with cone beam computed tomography. Jpn J Radiol 1–8. doi: 10.1007/s11604-014-0319-8 Sugiyama M, Fukuda T, Sanda Y et al (2014) Organized thrombus in pulmonary arteries in patients with chronic thromboembolic pulmonary hypertension; imaging with cone beam computed tomography. Jpn J Radiol 1–8. doi: 10.​1007/​s11604-014-0319-8
21.
Zurück zum Zitat Inami T, Kataoka M, Shimura N et al (2013) Pulmonary Edema Predictive Scoring Index (PEPSI), a new index to predict risk of reperfusion pulmonary edema and improvement of hemodynamics in percutaneous transluminal pulmonary angioplasty. JACC Cardiovasc Interv 6:725–736CrossRefPubMed Inami T, Kataoka M, Shimura N et al (2013) Pulmonary Edema Predictive Scoring Index (PEPSI), a new index to predict risk of reperfusion pulmonary edema and improvement of hemodynamics in percutaneous transluminal pulmonary angioplasty. JACC Cardiovasc Interv 6:725–736CrossRefPubMed
22.
Zurück zum Zitat Authors/Task Force Members:, Galiè N, Humbert M et al (2015) 2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension: The Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS)Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT). Eur Heart J ehv317. doi: 10.1093/eurheartj/ehv317 Authors/Task Force Members:, Galiè N, Humbert M et al (2015) 2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension: The Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS)Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT). Eur Heart J ehv317. doi: 10.​1093/​eurheartj/​ehv317
23.
Zurück zum Zitat Boyden EA (1961) The nomenclature of the bronchopulmonary segments and their blood supply: (As revised by the seventh international congress of anatomists, 1960). Chest 39:1–6 Boyden EA (1961) The nomenclature of the bronchopulmonary segments and their blood supply: (As revised by the seventh international congress of anatomists, 1960). Chest 39:1–6
24.
Zurück zum Zitat Schegerer AA, Lechel U, Ritter M et al (2014) Dose and image quality of cone-beam computed tomography as compared with conventional multislice computed tomography in abdominal imaging. Investig Radiol 49:675–684CrossRef Schegerer AA, Lechel U, Ritter M et al (2014) Dose and image quality of cone-beam computed tomography as compared with conventional multislice computed tomography in abdominal imaging. Investig Radiol 49:675–684CrossRef
Metadaten
Titel
Balloon pulmonary angioplasty: applicability of C-Arm CT for procedure guidance
verfasst von
Jan B. Hinrichs
Julius Renne
Marius M. Hoeper
Karen M. Olsson
Frank K. Wacker
Bernhard C. Meyer
Publikationsdatum
23.02.2016
Verlag
Springer Berlin Heidelberg
Erschienen in
European Radiology / Ausgabe 11/2016
Print ISSN: 0938-7994
Elektronische ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-016-4280-z

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