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.

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References

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