Percutaneous Transluminal Angioplasty and Stenting for Pulmonary Stenosis Due to Takayasu's Arteritis: Clinical Outcome and Four‐year Follow‐up

Abstract

Background: Percutaneous transluminal angioplasty and stent implantation for stenotic lesions of renal arteries and other branches of the aorta in Takayasu's arteritis have been reported to show good outcomes. However, this form of therapy has been reported in few cases with pulmonary artery involvement. Hypothesis: The aim of this study was to evaluate the role of this interventional treatment for pulmonary stenosis due to Takayasu's arteritis. Methods: A total of 4 patients (3 female and 1 male, ages 30-40 yrs) with Takayasu's pulmonary arteritis underwent percutaneous transluminal balloon angioplasty and stent implantation and were followed up for 1 to 4 years. Results: One patient underwent balloon angioplasty alone, 3 patients underwent balloon angioplasty and stent implantation. The stenoses were relieved acutely, oxygen saturation improved immediately due to improvement in lung perfusion and relief of dyspnea. The pressure gradient fell from 58.3 ± 8.7 mm Hg to 14 ± 3.2 mm Hg and mean pulmonary arterial pressure decreased from 48.5 ± 12.0 mm Hg to 37.3 ± 6.0 mm Hg. At a follow-up period of 34.5 ± 15.8 months, the patient with balloon angioplasty alone developed a recurrence of symptoms 18 months after the procedure. The other 3 patients continued to be asymptomatic and the stent remained patent without restenosis after the procedure. Conclusion: Percutaneous transluminal angioplasty and stent implantation is a safe and effective treatment in patients with pulmonary stenosis caused by Takayasu's arteritis.

Isolated peripheral pulmonary stenosis in Takayasu arteritis

“…Qin et al reported their experience in the management of four patients with pulmonary artery stenosis due to TA using percutaneous transluminal balloon angioplasty and stenting. The authors reported immediate success in all four cases and sustained relief in three patients in 4‐year follow‐up . Another report highlights successful management of a 45‐year‐old female patient with total occlusion of the RPA and significant stenosis of the LPA by surgical bypass grafting of the affected segment .…”

“…Although involvement of pulmonary arteries is not uncommon in TA, it often accompanies aortic involvement. Isolated stenosis of pulmonary artery branches as an initial manifestation is rarely encountered with only few published reports . It is commonly diagnosed after remarkable progression due to low clinical suspicion.…”

“…It is commonly diagnosed after remarkable progression due to low clinical suspicion. Presenting symptoms could be non‐specific and include dyspnea, fatigue, pulmonary hypertension and right‐sided heart failure in more advanced cases . Treatment strategy in these cases is much the same.…”

Pulmonary Vasculitis

“…Surgical therapies, including angioplasty, stenting, bypass, and even pulmonary artery replacement, have been reported to manage pulmonary artery stenosis in TA. 94,95 Generally, surgical interventions should only be undertaken once the disease is quiescent, and even then restenosis is common.…”

Lumped-Parameter Circuit Platform for Simulating Typical Cases of Pulmonary Hypertensions from Point of Hemodynamics

“…where r 0 is the initial radius and g r is used for changing rate. Clinical observations indicate that the resistance develops slowly and the progress may take years [19]. So, the time variable t in Eq.…”