Percutaneous balloon pulmonary angioplasty (BPA) may be an option for some patients who are not eligible for pulmonary thromboendarterectomy (PTE) surgery or have recurrent/persistent pulmonary hypertension following PTE.1 BPA is an emerging technique and should be reserved for expert centers with extensive training and experience.2
BPA opens obstructed vessels or widens stenotic lesions using a catheter-based intervention in order to restore pulmonary blood flow.1,2
BPA has been reported to improve2
Right ventricular function
BPA is recommended in patients who are technically inoperable or have residual PH after pulmonary endarterectomy surgery, PEA, and distal obstructions amenable to BPA.3
Pulmonary arterial imaging before and after percutaneous balloon pulmonary angioplasty (BPA).
a) Pre-procedure pulmonary angiogram demonstrating an intra-arterial fibrous “web” lesion; b) the corresponding intravascular ultrasound image showing the intravascular filling defect; c) the BPA balloon in place; d) pulmonary angiogram after the BPA procedure, showing the patent arterial lumen. Image from Lang et al 2017.1
BPA is a complex procedure that includes risk of complications and often requires multiple sessions. BPA requires extensive training and case experience, and should be reserved for expert centers with a CTEPH team.1,2
BPA can be considered for symptomatic CTEPH patients who are ineligible for PTE.2
BPA should not be considered for patients with large central clots or unilateral total occlusion.1
Reperfusion pulmonary edema
Pulmonary parenchymal bleeding
Hemorrhagic pleural effusions
Investigators have refined BPA by using smaller balloons and limiting the number of balloon inflations per session to 1 to 2 pulmonary vascular segments. Targeting only one lobe during each session and cautious balloon sizing have reduced the incidence of RPE to 2% in individual centers.4
1. Lang I, Meyer BC, Ogo T, et al. Balloon pulmonary angioplasty in chronic thromboembolic pulmonary hypertension. Eur Respir Rev. 2017;26:160119. 2. Kim NH, Delcroix M, Jais X, et al. Chronic thromboembolic pulmonary hypertension. Eur Respir J. 2019;53:1801915. 3. Humbert M, Kovacs G, Hoeper MM, et al. 2022 ESC/ERS guidelines for the diagnosis and treatment of pulmonary hypertension. Eur Heart J. 2022;43(38):3618-3731. 4. Galie N, Humbert M, Vachiery J, et al. 2015 ESC/ERS guidelines for the diagnosis and treatment of pulmonary hypertension. Eur Heart J. 2016;37(1):67-119.