• Naohiko Nakanishi, Kuniyoshi Fukai, Hideo Tsubata, Takehiro Ogata, Kan Zen, Takeshi Nakamura, Tetsuhiro Yamano, Hirokazu Shiraishi, Takeshi Shirayama, and Satoaki Matoba.
• Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan. Electronic address: naka-nao@koto.kpu-m.ac.jp.
• Heart Lung Circ. 2019 Apr 1; 28 (4): 655-659.

BackgroundChronic thromboembolic pulmonary hypertension (CTEPH) is a progressive disorder with a poor prognosis. Recently, balloon pulmonary angioplasty (BPA) has been reported to be an effective treatment for inoperable patients with CTEPH. However, this catheter-based treatment has potentially life-threatening vascular complications. To improve the efficacy and safety of BPA, we assessed the morphological evaluation of organised thrombus and the vascular injury by BPA procedure.MethodsIn this study, we assessed the morphology of organised thrombi and the vascular injury observed by angioscopy during BPA in 28 lesions from nine CTEPH patients.ResultsAngioscopy visualised various forms of organised thrombi such as 'Mesh', 'Slit', 'Flap' and 'Mass' and allowed for a detailed evaluation of organised thrombus that was difficult to do by conventional contrast angiography. In addition, after balloon dilation for BPA, angioscopy revealed a haemorrhage due to a vessel wall injury caused by wiring and/or ballooning.ConclusionsAssessment of organised thrombus and vascular injury by angioscopy might contribute to improving the treatment of the patients with CTEPH.Copyright © 2018 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.

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