title: Pulmonary vein stenting for the treatment of acquired severe pulmonary vein stenosis after pulmonary vein isolation: clinical implications after long-term follow-up of 4 years.
abstract: BACKGROUND
  Severe pulmonary vein stenosis (PVS) after catheter ablation of atrial fibrillation (AF) is a well-recognized complication with a further reported incidence of 1.3%. The preferred therapy for symptomatic PVS is pulmonary vein (PV) angioplasty, but this treatment modality is followed by restenosis in 44-70%. Whether there is additional long-term benefit from PVS stenting is uncertain. The aim of this study was the evaluation of the long-term success after PV stenting of severe stenosis.
  
  
  RESULTS
  Ten patients (pts) with 13 PVS were prospectively evaluated. PV stenting was performed with Palmaz Genesis stents. Magnetic resonance imaging (MRI), lung perfusion scans, and CT-scans were performed before, directly after, and every 12 months thereafter. Primary endpoint of the study was the occurrence of restenosis after PV stenting. After a median follow-up of 47.7 (IQRs 25/75 47.2-48.5) months, the primary endpoint was achieved in 3 out of 13 PVs (23% of the treated PVs). We observed two in-stent restenosis 2 and 4 years after PV stenting. These pts experienced onset of dyspnea some weeks before. After an additional balloon angioplasty, the in-stent restenosis was resolved. In one asymptomatic patient, we observed an occlusion of the PV stent 13 months poststenting. Normalization of lung perfusion was noted 4 years after PV stenting versus directly poststenting in all pts without in-stent restenosis (n = 7).
  
  
  CONCLUSIONS
  PVS stenting with stent sizes >or=10 mm seems to be an adequate therapy modality for treatment of severe acquired PVS. Late in-stent restenosis after PVS stenting can occur. The normalization of the initially disturbed lung perfusion scan is possible and remains stable, even 4 years after PVS stenting.
authors.affiliation: Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany. t.neumann@kerckhoff-klinik.de
authors.forename: Thomas
authors.initials: T
authors.lastname: Neumann
authors.forename: Malte
authors.initials: M
authors.lastname: Kuniss
authors.forename: Guido
authors.initials: G
authors.lastname: Conradi
authors.forename: Johannes
authors.initials: J
authors.lastname: Sperzel
authors.forename: Alexander
authors.initials: A
authors.lastname: Berkowitsch
authors.forename: Sergey
authors.initials: S
authors.lastname: Zaltsberg
authors.forename: Maciej
authors.initials: M
authors.lastname: Wojcik
authors.forename: Damir
authors.initials: D
authors.lastname: Erkapic
authors.forename: Thorsten
authors.initials: T
authors.lastname: Dill
authors.forename: Christian W
authors.initials: CW
authors.lastname: Hamm
authors.forename: Heinz-F
authors.initials: HF
authors.lastname: Pitschner
mesh_terms: D001807:Blood Vessel Prosthesis; D017115:Catheter Ablation / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000601:surgery*; D011668:Pulmonary Veno-Occlusive Disease / Q000209:etiology* / Q000601:surgery*; D015607:Stents; D016896:Treatment Outcome