Systematic Staged Percutaneous Balloon Pulmonary Angioplasty in Severe Inoperable Chronic Thromboembolic Pulmonary Hypertension

Introduction

The treatment for chronic thromboembolic pulmonary hypertension (CTEPH) is limited to pulmonary endarterectomy (PEA), drug therapy, and percutaneous balloon pulmonary angioplasty (BPA). The gold-standard treatment is PEA, and patients with CTEPH and proximal lesions are generally good surgical candidates. Perioperative complications and persistent pulmonary hypertension due to incomplete endarterectomy or secondary vasculopathy are typical problems after the procedure. A meta-analysis has shown that the efficacy of drug therapy for severe CTEPH is limited, and many patients do not achieve sufficiently reduced pulmonary artery (PA) pressure, even if exercise tolerance is marginally improved. Percutaneous BPA was first reported in 2001, but its safety was not proven at that time. As recently as one decade ago, pulmonary hypertension was first associated with poor prognosis. Fortunately, treatments for pulmonary hypertension have dramatically improved ever since, particularly for patients with CTEPH. BPA is still a challenging strategy, limited to a specific operator and facility, but its results have been improving.

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