Novel procedural method for balloon pulmonary angioplasty to treat chronic thromboembolic pulmonary hypertension

Abstract

Abstract Background The current strategy of balloon pulmonary angioplasty (BPA) for chronic thromboembolic pulmonary hypertension (CTEPH) is to dilate branches as many as possible without lung injury to normalize mean pulmonary artery pressure and oxygenation. The shape of guiding catheter is one of the important factors to achieve this strategy. However, conventional guiding catheters which are typically used for BPA are difficult to introduce into particular branches. The Ikari-curve left (IL) guiding catheter may be suitable for this purpose by adjusting its curves (Figure 1); however, its utility and effectiveness for lung injury are unclear. Purpose The aim of this study is to clarify utility and safety of IL guiding catheter for BPA. Methods We retrospectively analyzed 202 consecutive BPA sessions of 40 patients with CTEPH from November 2016 to October 2019 and divided them into two groups; IL group, in which we used IL guiding catheter; and non-IL group in which we used others. IL guiding catheter was used for branches of left lung which are difficult to introduce by conventional catheter prior Nov. 2018. After Nov.2018, we also used it for the same type branches of right lung. The occurrence of lung injury was determined by the presence of bloody sputum during the perioperative period. We compared success rate of introduction into target vessels and of occurrence of lung injury. Results The average age of enrolled patients was 60.3±14.4 year-old and female was 65%. There were 99 sessions in IL group. The median treated branches significantly differed between groups (IL group: 15 vs. non-IL group: 10, p<0.05). The lung injury rate tended to low in the IL group (4.0% vs. 11.7%, p=0.07). The IL group had more successful insertions into branches than did the non-IL group (right lung: middle lobe*, 84.4% vs. 57.5%; medial basal branch*, 46.9% vs. 7.5%; left lung: anterior ascending and descending branches, 82.9% vs. 70.8%; lingular branches*, 90.0% vs. 62.5%; anterior basal branch, 75.7% vs. 62.5%, * p<0.05). Conclusion IL guiding catheter can be introduced into branches that cannot be accessed via conventional guiding catheters and has potential to reduce the occurrence of lung injury. 2228 characters including space Figure1 Funding Acknowledgement Type of funding source: None