A 44-year-old man who had undergone paroxysmal atrial fibrillation (AF) ablation 3 times at another hospital underwent endovascular treatment (EVT) for left superior pulmonary vein occlusion (LSPVO) due to hemoptysis following the administration of dabigatran (300 mg/day). At the initial EVT, dilatations using a 6-mm×20-mm balloon restored blood flow in the LSPV (Figure A). However, at the 3-month follow-up, enhanced computed tomography (CT) showed the recurrence of LSPVO, so secondary EVT was performed to prevent recurrent hemoptysis. Serial optical coherence tomography (OCT) images after dilatation with a 2-mm balloon (Figure B–E) revealed a hyperplastic neointima, mimicking a combination of homogeneous and layered neointimal growth patterns after placement of a coronary drug-eluting stent.1 An Express stent (6×18 mm) maintained 3-month patency (Figure G). The patient was in good health at the 7-month follow-up under dabigatran and clopidogrel (75 mg/day).
Figure.
(A) Retrograde angiogram of left superior pulmonary vein (LSPV) after dilatation using a 6-mm balloon. (B–F) Cross-sectional optical coherence tomography images approximately 10.0 (B), 5.2 (C), 3.4 (D), and 0 mm (E) inside the LSPV ostium after dilatation with a 2-mm balloon, corresponding to the bookmarks (arrowheads) on the longitudinal image (F). Blue and green asterisks indicate homogeneous and layered neointimal growth patterns, respectively. (G) An enhanced computed tomography image showing the patency of the Express stent after 3 months.
Using OCT provided novel intravascular insights into the pulmonary vein occlusion after AF ablation, indicating more aggressive restenosis compared with pulmonary vein stenosis2 and highlighting the need for careful ablation to avoid inducing inflammation inside the pulmonary vein.
Disclosures
I.T. is a member of Circulation Reports’ Editorial Team. The other authors have no conflicts of interest to declare.
References
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