Abstract
BACKGROUND: Balloon pulmonary angioplasty (BPA) and pulmonary endarterectomy (PEA) are established treatments for chronic thromboembolic pulmonary hypertension (CTEPH). In cases where BPA is ineffective, stent implantation emerges as salvage therapy. However, stent implantation during BPA remains a subject of debate. METHODS: This seven-year case series in Serbia, where PEA is unavailable, examines outcomes in 10 CTEPH patients undergoing BPA with coronary-type stent implantation during BPA. Objectives include assessing the feasibility, safety, and efficacy of this combined approach, identifying optimal patient selection criteria. Criteria for stent placement included persistent unsatisfactory flow post-multiple balloon dilatations. Follow-up assessments were via repeat pulmonary angiography. RESULTS: Stents were successfully deployed, demonstrating sustained patency in 14 of 15 stents over an average 21.5-month (ranging from 11 up to 82 months) follow-up. Outcomes revealed significant reductions in mean pulmonary artery pressure, improvements in WHO Functional Class, and enhanced 6-minute walking distance. For the first 6 months, patients received daily clopidogrel 75 mg and rivaroxaban 15 mg, without significant bleeding. Dual therapy for pulmonary hypertension was consistently upheld. During the follow-up period, no stent thrombosis, restenosis, or other severe acute or chronic complications were observed; however, in one case, additional balloon stent post-dilatation was required. CONCLUSION: Coronary-type stent implantation during BPA for selected CTEPH patients, though not a primary treatment, proved valuable, offering a potential solution when BPA alone falls short. This case series emphasizes the need to refine patient selection criteria for this emerging therapeutic avenue.