title: Novel Angiographic Classification of Each Vascular Lesion in Chronic Thromboembolic Pulmonary Hypertension Based on Selective Angiogram and Results of Balloon Pulmonary Angioplasty.
abstract: Balloon pulmonary angioplasty (BPA) is an alternative therapy for patients with chronic thromboembolic pulmonary hypertension who are ineligible for standard therapy, pulmonary endarterectomy. Although there are several classifications of vascular lesions, these classifications are based on the features of the specimen removed during pulmonary endarterectomy. Because organized thrombi are not removed during balloon pulmonary angioplasty, we attempted to establish a new classification of vascular lesions based on pulmonary angiographic images. We evaluated the success and complication rate of BPA in accordance with the location and morphology of thromboembolic lesions.
  
  
  
  We reviewed 500 consecutive procedures (1936 lesions) of BPA in 97 patients with chronic thromboembolic pulmonary hypertension and investigated the outcomes of BPA based on the lesion distribution and the angiographic characteristics of the thromboembolic lesions, as follows: type A, ring-like stenosis lesion; type B, web lesion; type C, subtotal lesion; type D, total occlusion lesion, and type E, tortuous lesion. The success rate was higher, and the complication rate was lower in ring-like stenosis and web lesions. The total occlusion lesions had the lowest success rate. Tortuous lesions were associated with a high complication rate and should be treated only by operators with extensive experience with BPA.
  
  
  
  We modified the previous angiographic classification and established a new classification for each vascular lesion. We clarified that the outcome and complication rate of the BPA are highly dependent on the lesion characteristics.
authors.affiliation: From the Department of Cardiology (T.K., K.M., H. Mizoguchi, H.S., T.N., T.O., K.Y., M.M., H. Matsubara) and Department of Clinical Science (A.O., H. Matsubara), National Hospital Organization Okayama Medical Center, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Kawakami
authors.affiliation: From the Department of Cardiology (T.K., K.M., H. Mizoguchi, H.S., T.N., T.O., K.Y., M.M., H. Matsubara) and Department of Clinical Science (A.O., H. Matsubara), National Hospital Organization Okayama Medical Center, Japan.
authors.forename: Aiko
authors.initials: A
authors.lastname: Ogawa
authors.affiliation: From the Department of Cardiology (T.K., K.M., H. Mizoguchi, H.S., T.N., T.O., K.Y., M.M., H. Matsubara) and Department of Clinical Science (A.O., H. Matsubara), National Hospital Organization Okayama Medical Center, Japan.
authors.forename: Katsumasa
authors.initials: K
authors.lastname: Miyaji
authors.affiliation: From the Department of Cardiology (T.K., K.M., H. Mizoguchi, H.S., T.N., T.O., K.Y., M.M., H. Matsubara) and Department of Clinical Science (A.O., H. Matsubara), National Hospital Organization Okayama Medical Center, Japan.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Mizoguchi
authors.affiliation: From the Department of Cardiology (T.K., K.M., H. Mizoguchi, H.S., T.N., T.O., K.Y., M.M., H. Matsubara) and Department of Clinical Science (A.O., H. Matsubara), National Hospital Organization Okayama Medical Center, Japan.
authors.forename: Hiroto
authors.initials: H
authors.lastname: Shimokawahara
authors.affiliation: From the Department of Cardiology (T.K., K.M., H. Mizoguchi, H.S., T.N., T.O., K.Y., M.M., H. Matsubara) and Department of Clinical Science (A.O., H. Matsubara), National Hospital Organization Okayama Medical Center, Japan.
authors.forename: Takanori
authors.initials: T
authors.lastname: Naito
authors.affiliation: From the Department of Cardiology (T.K., K.M., H. Mizoguchi, H.S., T.N., T.O., K.Y., M.M., H. Matsubara) and Department of Clinical Science (A.O., H. Matsubara), National Hospital Organization Okayama Medical Center, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Oka
authors.affiliation: From the Department of Cardiology (T.K., K.M., H. Mizoguchi, H.S., T.N., T.O., K.Y., M.M., H. Matsubara) and Department of Clinical Science (A.O., H. Matsubara), National Hospital Organization Okayama Medical Center, Japan.
authors.forename: Kei
authors.initials: K
authors.lastname: Yunoki
authors.affiliation: From the Department of Cardiology (T.K., K.M., H. Mizoguchi, H.S., T.N., T.O., K.Y., M.M., H. Matsubara) and Department of Clinical Science (A.O., H. Matsubara), National Hospital Organization Okayama Medical Center, Japan.
authors.forename: Mitsuru
authors.initials: M
authors.lastname: Munemasa
authors.affiliation: From the Department of Cardiology (T.K., K.M., H. Mizoguchi, H.S., T.N., T.O., K.Y., M.M., H. Matsubara) and Department of Clinical Science (A.O., H. Matsubara), National Hospital Organization Okayama Medical Center, Japan. matsubara.hiromi@gmail.com.
authors.forename: Hiromi
authors.initials: H
authors.lastname: Matsubara
mesh_terms: D000368:Aged; D000792:Angiography; D000800:Angioplasty, Balloon / Q000009:adverse effects; D002908:Chronic Disease; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000000981:diagnostic imaging* / Q000209:etiology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011651:Pulmonary Artery / Q000000981:diagnostic imaging*; D011655:Pulmonary Embolism / Q000145:classification / Q000150:complications / Q000000981:diagnostic imaging* / Q000628:therapy*; D012189:Retrospective Studies; D000071079:Stenosis, Pulmonary Artery / Q000145:classification / Q000000981:diagnostic imaging* / Q000209:etiology / Q000628:therapy*; D009626:Terminology as Topic; D016896:Treatment Outcome
keywords: angiography; angioplasty; arterial pressure; coronary artery disease; hypertension, pulmonary