Drug-Coated Balloon Venoplasty to Treat Iatrogenic Pulmonary Vein Stenosis

Intravascular Shockwave Lithotripsy: An Adjunct to Balloon Angioplasty for Calcified Pulmonary Vein Stenosis

Pulmonary vein stenosis occurs in 0.4% to 2% of cases after atrial fibrillation ablation. Patients experience chest pain or shortness of breath when pulmonary vein narrowing exceeds 60% or its diameter falls below 4 to 6 mm. To our knowledge, this is the first case report of the use of shockwave intravascular lithotripsy to address calcified pulmonary vein stenosis after the conventional approach of balloon angioplasty failed to result in expansion. Our case highlights that shockwave intravascular lithotripsy is a feasible, safe, and effective adjunctive therapy for treating calcified pulmonary vein stenosis.

Incidence and predictors of in-stent restenosis following intervention for pulmonary vein stenosis due to fibrosing mediastinitis

BACKGROUND

Fibrosing mediastinitis (FM) is a rare yet fatal condition, caused by different triggers and frequently culminating in the obstruction of the pulmonary vasculature and airways, often leading to pulmonary hypertension and right heart failure. Percutaneous transluminal pulmonary venoplasty (PTPV) is an emerging treatment for pulmonary vein stenosis (PVS) caused by FM. Our previous study showed as high as 24% of in-stent restenosis (ISR) in FM. However, the predictors of ISR are elusive.

OBJECTIVES

We sought to identify the predictors of ISR in patients with PVS caused by extraluminal compression due to FM.

METHODS

We retrospectively enrolled patients with PVS-FM who underwent PTPV between July 1, 2018, and December 31, 2022. According to ISR status, patients were divided into two groups: the ISR group and the non-ISR group. Baseline characteristics (demographics and lesions) and procedure-related information were abstracted from patient records and analyzed. Univariate and multivariate analyses were performed to determine the predictors of ISR.

RESULTS

A total of 142 stents were implanted in 134 PVs of 65 patients with PVS-FM. Over a median follow-up of 6.6 (3.4-15.7) months, 61 of 134 PVs suffered from ISR. Multivariate analysis demonstrated a significantly lower risk of ISR in PVs with a larger reference vessel diameter (RVD) (odds ratio (OR): 0.79; 95% confidence interval [CI]: 0.64 to 0.98; P = 0.032), and stenosis of the corresponding pulmonary artery (Cor-PA) independently increased the risk of restenosis (OR: 3.41; 95% CI: 1.31 to 8.86; P = 0.012). The cumulative ISR was 6.3%, 21.4%, and 39.2% at the 3-, 6-, and 12-month follow-up, respectively.

CONCLUSION

ISR is very high in PVS-FM, which is independently associated with RVD and Cor-PA stenosis.

TRAIL REGISTRATION

Chinese Clinical Trials Register; No.: ChiCTR2000033153. URL: http://www.chictr.org.cn .

Novel Use of Drug-Coated Balloon Angioplasty to Treat Pulmonary Vein Stenosis

Pulmonary vein stenosis is challenging to treat due to high rate of recurrence. Multiple interventions exist but are limited by high rates of restenosis. One theory for the high rate of recurrence is vascular inflammation. Drug-coated balloon angioplasty has been used to limit restenosis caused by inhibiting inflammation in pulmonary vein stenosis.

Pulmonary Vein Intervention for Severe Pulmonary Vein Stenosis After Atrial Fibrillation Ablation - A Retrospective Cohort Study

BACKGROUND

Pulmonary vein (PV) stenosis (PVS) is a serious complication of atrial fibrillation (AF) ablation. The objective of this study was to describe interventional treatments for PVS after AF ablation and long-term outcomes in Japanese patients.

METHODS AND RESULTS

This multicenter retrospective observational study enrolled 30 patients (26 [87%] male; median age 55 years) with 56 severe PVS lesions from 43 PV interventional procedures. Twenty-seven (90%) patients had symptomatic PVS and 19 (63%) had a history of a single AF ablation. Of the 56 lesions, 41 (73%) were de novo lesions and 15 (27%) were retreated. Thirty-three (59%) lesions were treated with bare metal stents, 14 (25%) were treated with plain balloons, and 9 (16%) were treated with drug-coated balloons. All lesions were successfully treated without any systemic embolic event. Over a median follow-up of 584 days (interquartile range 265-1,165 days), restenosis rates at 1 and 2 years were 35% and 47%, respectively. Multivariate Cox regression analysis revealed devices <7 mm in diameter (hazard ratio [HR] 2.52; 95% confidence interval [CI] 1.04-6.0; P=0.040) and totally occluded lesions (HR 3.33; 95% CI 1.21-9.15; P=0.020) were independent risk factors for restenosis.

CONCLUSIONS

All PVS lesions were successfully enlarged by the PV intervention; however, restenosis developed in approximately half the lesions within 2 years.