Author + information
- Nickolay Danilov1,
- Yura Matchin2,
- Kirill Mershin2,
- Olesya Sagaydak2,
- Sergey Yarovoy2 and
- Irina Chazova2
The gold standard therapy for CTEPH is pulmonary endarterectomy (PEA). However,1/3 of CTEPH cases are inoperable due to high-risk status because of distal lesions, high pulmonary vascular resistance (PVR) and comorbidities. Balloon pulmonary angioplasty (BPA) is being considered in technically non-operable patients but there is no data on the use of BPA in high-risk patients with proximal lesions.
We analyzed 64 procedures in 13 CTEPH patients who ended BPA course and there were no more arteries suitable for BPA. According to traditional classification we divided patients into two groups: 1gr (n=7) - patients with proximal lesions (Type 1 or 2 disease) and 2gr (n=6) – patients with distal lesions (Type 3 disease). Multidisciplinary team refused PEA for patients with proximal lesions for the following reasons: blood diseases–3 cases, PVR>1100 dynes·s·cm5–2 cases, left main compression syndrome–1 case, impossibility of antiplatelet drugs cancellation after coronary stenting–1 case. Mean amount of BPA sessions per patient was 4.9 ± 2.0. Percutaneous access for BPA was done via antecubital vein. We used 8F short and long 6F sheathes with 6F guiding MPA or JR4 catheter. After crossing the lesion with Fielder XT-R guidewire several dilatations with 2-8 mm balloons at 10-12 atm were performed. Angiography after BPA showed improvement in blood flow with better prepleural perfusion and venous return in all cases.
There was no difference between groups at baseline data as well as in the amount of sessions per patient. Improvement in pulmonary flow grade (ΔPFG) per session was similar in both groups (2.9 ± 1.3 vs 2.8 ± 1.7) after BPA. There was also no difference in pulmonary edema predictor scoring index (PEPSI) 25.31 ± 15.57 vs 25.47 ± 17.16. Serious complications were not observed. Mean pulmonary artery pressure after treatment in 1 gr was significantly lower (27.6 ± 5 vs 39 ± 10.9 mm Hg, p<0.05). PVR after treatment was also lower in 1 gr (449.9 ± 229.1 vs 678.0 ± 322.3 dynes·s·cm5, p<0.05) and ΔPVR was respectively higher (485.7 ± 285.3 vs 273.8 ± 243.0 dynes·s·cm5, p<0.05). 6MWT and BNP level significantly improved from the baseline but did not differ between groups: Δ6MWT (209,3 ± 47,6 vs 159,0 ± 157,3 m), ΔBNP (154,6 ± 402,1 vs 188,2 ± 268 pg/mL).
Balloon pulmonary angioplasty in non-operable CTEPH patients with proximal pulmonary artery lesions is no less safe and effective than in patients with distal lesions. BPA can be considered as an alternative to PEA in high-risk CTEPH patients with proximal pulmonary artery lesions.
ENDOVASCULAR: Hypertension Therapies and Renal Denervation