Patients diagnosed with chronic thromboembolic pulmonary hypertension (CTEPH) have a very poor prognosis if their condition is left untreated.2,3 Pulmonary endarterectomy may be a curative treatment for the proximal type of CTEPH,4 but the surgical approach for the distal type of CTEPH is difficult.5 BPA appears to be a promising treatment option in patients with inoperable CTEPH because of an improvement in pulmonary circulation, symptoms, and life prognosis; however, the complication ratio differs across studies.6-16
Therefore, researchers in Tokyo sought to evaluate the risk factors of complications of BPA and assessed the mechanisms of these complications in 30 patients with 879 lesions (112 sessions) on BPA-related images. They found that 122 (99.2%) of 123 complications were confirmed to be associated with BPA procedures at the local area. Inclusive lesions were the sole independent predictor of procedure-related complications (P =.002), whereas hemodynamic parameters were not predictors of complications. Computed tomography scan images after BPA were useful for identifying bleeding complications and to predict hemoptysis.
Thus, the complication rate of BPA is relatively higher than coronary or peripheral interventions because of the movement of lung by breath and the fragility of pulmonary arteries.1 The authors concluded that, “Lesion morphology was the sole predictor of BPA-related complications, while hemodynamic parameters were not associated with the frequency of complications.” Because computed tomography scans contributed to the recognition of procedure-related complications and the operator’s learning curve, the authors recommended the potential use of computed tomography scanning after BPA to occlusive lesions.
- Ikeda N, Kubota S, Okazaki T, Iijima R, Hara H, Hiroi Y, Nakamura M. The predictors of complications in balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension [published online February 17, 2019]. Catheter Cardiovasc Interv. doi: 10.1002/ccd.28133
- Simonneau G, Gatzoulis MA, Adatia I, et al. Updated clinical classification of pulmonary hypertension. J Am Coll Cardiol. 2013;62:D34-D41.
- Riedel M, Stanek V, Widimsky J, Prerovsky I. Longterm follow-up of patients with pulmonary thromboembolism. Late prognosis and evolution of hemodynamic and respiratory data. Chest. 1982;81(2):151-158.
- Kim NH, Delcroix M, Jenkins DP, et al. Chronic thromboembolic pulmonary hypertension. J Am Coll Cardiol. 2013;62(25 Suppl):D92-D99.
- Jamieson SW, Auger WR, Fedullo PF, Channick RN, Kriett JM, Tarazi RY, Moser KM. Experience and results with 150 pulmonary thromboendarterectomy operations over a 29-month period. J Thorac Cardiovasc Surg. 1993;106(1):116-126.
- Feinstein JA, Goldhaber SZ, Lock JE, Ferndandes SM, Landzberg MJ. Balloon pulmonary angioplasty for treatment of chronic thromboembolic pulmonary hypertension. Circulation. 2001;103(1):10-13.
- Mizoguchi H, Ogawa A, Munemasa M, Mikouchi H, Ito H, Matsubara H. Refined balloon pulmonary angioplasty for inoperable patients with chronic thromboembolic pulmonary hypertension. Circ Cardiovasc Interv. 2012;5(6):748-755.
- Inami T, Kataoka M, Shimura N, et al. Pressure-wire-guided percutaneous transluminal pulmonary angioplasty: a breakthrough in catheter-interventional therapy for chronic thromboembolic pulmonary hypertension. JACC Cardiovasc Interv. 2014;7(11):1297-1306.
- Yanagisawa R, Kataoka M, Inami T, et al. Efficacy of 360-degree three-dimensional rotational pulmonary angiography to guide percutaneous transluminal pulmonary angioplasty. EuroIntervention. 2014;9(12):1483.
- Ishiguro H, Kataoka M, Inami T, et al. Percutaneous transluminal pulmonary angioplasty for central-type chronic thromboembolic pulmonary hypertension. JACC Cardiovasc Interv. 2013;6(11):1212-1213.
- Sugimura K, Fukumoto Y, Satoh K, et al. Percutaneous transluminal pulmonary angioplasty markedly improves pulmonary hemodynamics and long-term prognosis in patients with chronic thromboembolic pulmonary hypertension. Circ J. 2012;76(2):485-488.
- Inami T, Kataoka M, Ando M, Fukuda K, Yoshino H, Satoh T. A new era of therapeutic strategies for chronic thromboembolic pulmonary hypertension by two different interventional therapies; pulmonary endarterectomy and percutaneous transluminal pulmonary angioplasty. PLoS One. 2014;9(11):e94587.
- Inami T, Kataoka M, Ishiguro H, Yanagisawa R, Shimura N, Yoshino H, Satoh T. Percutaneous transluminal pulmonary angioplasty for chronic thromboembolic pulmonary hypertension with severe right heart failure. Am J Respir Crit Care Med. 2014;189(11):1437-1439.
- Yanagisawa R, Kataoka M, Inami T, et al. Safety and efficacy of percutaneous transluminal pulmonary angioplasty in elderly patients. Int J Cardiol. 2014;175(2):285-289.
- Kataoka M, Inami T, Hayashida K, et al. Percutaneous transluminal pulmonary angioplasty for the treatment of chronic thromboembolic pulmonary hypertension. Circ Cardiovasc Interv. 2012;5(6):756-762.
- Andreassen AK, Ragnarsson A, Gude E, Geiran O, Andersen R. Balloon pulmonary angioplasty in patients with inoperable chronic thromboembolic pulmonary hypertension. Heart. 2013;99(19):1415-1420.