Abstract
Balloon pulmonary angioplasty (BPA) is an effective treatment for inoperable chronic thromboembolic pulmonary hypertension (CTEPH). The purpose of this study is to evaluate the therapeutic effect and safety of the non-slip element percutaneous transluminal angioplasty (NSE PTA) scoring balloons in BPA. 108 pulmonary artery branches in 14 CTEPH patients who underwent BPA using NSE PTA scoring balloon (the NSE PTA group) or plain balloon (the POBA group) and pressure gradient evaluation were analyzed. We compared the improvement of the pressure ratios after BPA (Δ Pressure ratio) of both groups. There was no significant difference in the Δ Pressure ratios of the two groups (0.241 ± 0.196 POBA, 0.259 ± 0.177 NSE PTA, p = 0.63). No complications occurred in the NSE PTA group, while 3 episodes of hemoptysis were seen in the POBA group. This, however, was not found to be significant (p = 0.27). In the cases where balloon-to-vessel ratio exceeded 1.0 (n = 35), multivariate analysis showed that the use of NSE PTA scoring balloon and pressure ratio before BPA were significantly correlated with Δ Pressure ratio (β coefficient: 0.047, 95% CI: 0.0016 to 0.093, p = 0.043 and β coefficient: -0.60, 95% CI: -0.78 to -0.42, p < 0.01, respectively). Although NSE PTA scoring balloon was safe, there was no significant pressure gradient improvement with NSE PTA scoring balloon compared to conventional BPA. Nevertheless, the NSE PTA scoring balloon showed effective blood-flow improvement in the case of large balloon-to-vessel ratio.
Highlights
Chronic thromboembolic pulmonary hypertension (CTEPH) is a progressive disease associated with increased pulmonary vascular resistance and pulmonary hypertension (PH) as a result of organized thromboses, clinically classified as Group 4 PH [1]
No complications occurred in the non-slip element percutaneous transluminal angioplasty (NSE PTA) group, while 3 episodes of hemoptysis were seen in the plain old balloon angioplasty (POBA) group
In the cases where balloon-to-vessel ratio exceeded 1.0 (n = 35), multivariate analysis showed that the use of NSE PTA scoring balloon and pressure ratio before balloon pulmonary angioplasty (BPA) were significantly correlated with Δ Pressure ratio (β coefficient: 0.047, 95% CI: 0.0016 to 0.093, p = 0.043 and β coefficient: −0.60, 95% CI: −0.78 to −0.42, p < 0.01, respectively)
Summary
Chronic thromboembolic pulmonary hypertension (CTEPH) is a progressive disease associated with increased pulmonary vascular resistance and pulmonary hypertension (PH) as a result of organized thromboses, clinically classified as Group 4 PH [1]. In spite of therapeutic developments, the prognosis of CTEPH remains poor. Pulmonary endarterectomy (PEA) reduces pulmonary arterial pressure and improves symptoms and prognosis in patients with surgically accessible CTEPH [2–5]. For inoperable patients or patients with residual pulmonary hypertension after PEA, pulmonary vasodilators such as soluble guanylate cyclase stimulators are indicated [6, 7]. The efficacy of balloon pulmonary angioplasty (BPA) has been reported for the treatment of inoperable CTEPH. BPA has been shown to improve symptoms, exercise tolerance, right heart function, and long-term prognosis in patients with CTEPH [8–10]. Balloon pulmonary angioplasty (BPA) is an effective treatment for inoperable chronic thromboembolic pulmonary hypertension (CTEPH). The purpose of this study is to evaluate the therapeutic effect and safety of the non-slip element percutaneous transluminal angioplasty (NSE PTA) scoring balloons in BPA
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