Balloon Sizing of Pulmonary Branch Stenosis: A Useful Method to Guide Stent Implantation

Volume 15 - Issue 8 - August, 2003
Posted on: 3/14/12
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Author(s):

Ashraf M. Nagm, MD and John W. Moore, MD, MPH

ABSTRACT: Among patients with congenital heart disease, pulmonary branch stenosis is a common indication for stent implantation. Selective calibrated angiography is the standard method of vessel sizing to guide angioplasty balloon and stent selection. Our aim was to compare vessel dimensions from standard calibrated selective angiography with those obtained using a compliant sizing balloon catheter. Methods. 9 patients with 11 pulmonary branch stenoses underwent selective calibrated angiography. Amplatzer sizing balloon catheters positioned across the stenoses were inflated with dilute contrast agent. Digital angiograms were repeated in the same projections. Measurements from both methods were analyzed statistically. Minimum, maximum proximal and maximum distal vessel diameters were all significantly larger (p < 0.01) when measured by the sizing balloon method. Angioplasty balloons and stent diameters were chosen according to the sizing balloon measurements. In 7 of 8 stented lesions, larger angioplasty balloon diameters were selected for stent implantation than would have been chosen by standard angiography. Calibrated selective angiography may undersize vessel diameters. Use of a compliant sizing balloon appears to offer an accurate method to guide stent implantation in pulmonary branch stenosis.

J INVAS CARDIOL 2003;15:437–438

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Intravascular stent implantation is the preferred treatment for native and post-operative branch pulmonary stenosis.^1–4 The standard procedure for stent placement¹ includes calibrated angiography, which has been regarded as the optimal calibration method for size estimation.⁵ The selection of angioplasty balloon catheter diameters and stents depends upon measurements of the stenosed vessel diameters determined by calibrated angiography. The aim of this technical report was to compare vessel dimensions determined by standard calibrated angiography to those obtained with the use of a compliant sizing balloon catheter. The impact of this comparison on the selection of the angioplasty balloon catheter diameter and stent was determined.