Improving Balloon Pulmonary Angioplasty Through Target Endpoint Optimization With Pressure Catheter and Angiographic Lung Perfusion.

Background: Balloon pulmonary angioplasty (BPA) has exhibited substantial progress in the management of chronic thromboembolic pulmonary hypertension (CTEPH). However, nearly one-half of the patients with CTEPH experience persistent pulmonary hypertension after undergoing BPA, emphasizing the need for enhanced therapies.
Objectives: The authors sought to investigate the clinical significance of functional assessment-guided dilation of the pulmonary artery (PA) in patients with CTEPH undergoing BPA treatment.
Methods: The prospective single-center cohort study enrolled 95 patients who underwent 278 consecutive BPA sessions. Lung parenchymal perfusion was assessed via 2-dimensional perfusion angiography, and pressure catheter measurements were taken to determine the PA pressure ratios. The correlation between lung perfusion and the pressure ratio was analyzed to establish an optimal target pressure ratio. Patients were stratified into 2 groups, a pressure-guided group (n = 28) and an angiographic group (n = 63), to evaluate whether optimizing the pressure ratio led to improvements in residual PH and complications.
Results: The pressure ratio and lung perfusion measurements of 141 PA lesions were analyzed. A piecewise linear regression model identified a target pressure ratio of 0.7, associated with significant enhancement in lung perfusion. The pressure-guided strategy achieved a higher rate of mean pulmonary artery pressure <25 mm Hg (92.8% [26/28 patients] vs 60.3% [38/63 patients]; P = 0.001) and a concurrent reduction in BPA relevant complications (3.9% [4/101 sessions] vs 12.9% [23/177 sessions]; P = 0.019).
Conclusions: Functional assessment-guided PA dilation with a target pressure ratio of 0.7 proved beneficial in BPA treatment for patients with CTEPH. This approach improved the residual PH and reduced complications, highlighting its potential to enhance CTEPH management outcomes.
Competing Interests: Funding Support and Author Disclosures The present study was supported by Japan Agency for Medical Research and Development under grant number 22ek0210149h0003. Dr S.Y. has received grants support from Takeda Pharmaceutical, Abbott, and Boston Scientific and lecture fees from Daiichi-Sankyo and Bristol Myers Squibb. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
(Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)