TY - JOUR
T1 - Emerging Role of Balloon Pulmonary Angioplasty in Chronic Thromboembolic Pulmonary Disease—Insights from the 2022 ESC Guidelines
AU - Banaszkiewicz, Marta
AU - Kurzyna, Paweł
AU - Kubikowska, Nina
AU - Mucha, Magda
AU - Rudnik, Aleksander
AU - Gąsecka, Aleksandra
AU - Pietrasik, Arkadiusz
AU - Grabowski, Marcin
AU - Jaguszewski, Miłosz J.
AU - Kasprzyk, Piotr
AU - Kędzierski, Piotr
AU - Ciećwierz, Dariusz
AU - Żuk, Grzegorz
AU - Szwed, Piotr
AU - Piłka, Michał
AU - Florczyk, Michał
AU - Kurzyna, Marcin
AU - Darocha, Szymon
N1 - Funding Information: This manuscript was supported by the Centre of Postgraduate Medical Education, project number: 501-1-054-25-23. Publisher Copyright: © 2023 by the authors.
PY - 2023/8/1
Y1 - 2023/8/1
N2 - In this article, we discuss the topic of chronic thromboembolic pulmonary disease (CTEPD) and the growing role of balloon pulmonary angioplasty (BPA) in its treatment. We present the pathophysiology of CTEPD which arises from an incomplete resolution of thrombi in the pulmonary arteries and leads to stenosis and occlusion of the vessels. The article focuses mainly on the chronic thromboembolic pulmonary hypertension (CTEPH) subpopulation for which prognosis is very poor when left untreated. We describe a multimodal approach to treating CTEPH, including pulmonary endarterectomy (PEA), BPA, and pharmacological therapies. Additionally, the benefits of pharmacological pre-treatment before BPA and the technical aspects of the procedure itself are outlined. It is emphasized that BPA does not replace PEA but serves as a complementary treatment option for eligible patients. We summarized efficacy and treatment goals including an improvement in functional and biochemical parameters before and after BPA. Patients who received pre-treatment with riociguat prior to BPA exhibited a notable reduction in the occurrence of less severe complications. However, elderly patients are still perceived as an especially vulnerable group. It is shown that the prognosis of patients undergoing BPA is similar to PEA in the first years after the procedure but the long-term prognosis of BPA still remains unclear. The 2022 ESC/ERS guidelines highlight the significant role of BPA in the multimodal treatment of CTEPH, emphasizing its effectiveness and recommending its consideration as a therapeutic option for patients with CTEPD, both with and without pulmonary hypertension. This review summarizes the available evidence for BPA, patient selection, procedural details, and prognosis and discusses the potential future role of BPA in the management of CTEPH.
AB - In this article, we discuss the topic of chronic thromboembolic pulmonary disease (CTEPD) and the growing role of balloon pulmonary angioplasty (BPA) in its treatment. We present the pathophysiology of CTEPD which arises from an incomplete resolution of thrombi in the pulmonary arteries and leads to stenosis and occlusion of the vessels. The article focuses mainly on the chronic thromboembolic pulmonary hypertension (CTEPH) subpopulation for which prognosis is very poor when left untreated. We describe a multimodal approach to treating CTEPH, including pulmonary endarterectomy (PEA), BPA, and pharmacological therapies. Additionally, the benefits of pharmacological pre-treatment before BPA and the technical aspects of the procedure itself are outlined. It is emphasized that BPA does not replace PEA but serves as a complementary treatment option for eligible patients. We summarized efficacy and treatment goals including an improvement in functional and biochemical parameters before and after BPA. Patients who received pre-treatment with riociguat prior to BPA exhibited a notable reduction in the occurrence of less severe complications. However, elderly patients are still perceived as an especially vulnerable group. It is shown that the prognosis of patients undergoing BPA is similar to PEA in the first years after the procedure but the long-term prognosis of BPA still remains unclear. The 2022 ESC/ERS guidelines highlight the significant role of BPA in the multimodal treatment of CTEPH, emphasizing its effectiveness and recommending its consideration as a therapeutic option for patients with CTEPD, both with and without pulmonary hypertension. This review summarizes the available evidence for BPA, patient selection, procedural details, and prognosis and discusses the potential future role of BPA in the management of CTEPH.
KW - balloon pulmonary angioplasty
KW - chronic thromboembolic pulmonary disease
KW - chronic thromboembolic pulmonary hypertension
KW - pulmonary endarterectomy
KW - pulmonary hypertension
UR - http://www.scopus.com/inward/record.url?scp=85169148872&partnerID=8YFLogxK
U2 - https://doi.org/10.3390/jcm12165336
DO - https://doi.org/10.3390/jcm12165336
M3 - Review article
C2 - 37629379
SN - 2077-0383
VL - 12
JO - Journal of clinical medicine
JF - Journal of clinical medicine
IS - 16
M1 - 5336
ER -