https://orcid.org/0000-0002-9147-0379
A 75-year-old man who was diagnosed with inoperable chronic thromboembolic pulmonary hypertension underwent balloon pulmonary angioplasty (BPA) in his right lower lobe pulmonary artery (Panel A). Soon after the ballooning, rupture of the pulmonary artery occurred (Panel B and Supplementary data online, Video S1). We urgently observed the lesion with intravascular ultrasound (IVUS) and recognized that part of the vessel wall structure had disappeared (allows in Panel C and Supplementary data online, Video S2). After IVUS observation, we rapidly placed two covered-stents (JOSTENT GraftMaster, Abbott Vascular, Santa Clara, CA, USA) to stop bleeding, and pulmonary angiography revealed the disappearance of extravasation of contrast medium (Panel D and Supplementary data online, Video S3). In IVUS observation, the ruptured lesion was repaired with covered-stents (Panel E and Supplementary data online, Video S4). Chest computed tomography taken 30 days after BPA showed encapsulated pulmonary haemorrhage and a high-density image of covered-stents in the right lower lobe (white allow in Panel F). Unlike guidewire perforation, the IVUS images demonstrated that the vessel wall structure was partially lost. In such a case, treatment with a covered-stent may be the only way to bail out of a nightmare. Although there have been a few reports of treating pulmonary artery rupture with covered-stents, to our best knowledge, this is the first report to show IVUS images of ruptured pulmonary artery during BPA.
Supplementary data are available at European Heart Journal - Cardiovascular Imaging online.
