An overview of balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension

Keiichiro Kuronuma, Hiroto Shimokawahara, Hiromi Matsubara

Research output: Contribution to journalReview articlepeer-review

Abstract

Introduction: Chronic thromboembolic pulmonary hypertension (CTEPH) is a severe and progressive condition caused by unresolved pulmonary arterial obstructions, leading to secondary microvasculopathy and poor hemodynamics. Pulmonary endarterectomy (PEA) is the first-line treatment for operable patients. Balloon pulmonary angioplasty (BPA) has emerged as a promising treatment option for patients considered inoperable due to distal lesions, comorbidities, or residual pulmonary hypertension (PH) after PEA. Following the development of the BPA in safety and efficacy, it has been widely adopted and utilized across the globe. Areas covered: This review covers the historical development of BPA, its clinical role, and technical methodologies. Medical therapies as an adjunctive role in CTEPH management are also discussed. Finally, we present recent BPA experiences from our institution, highlighting hemodynamic outcomes and survival rates. Expert opinion: BPA is a transformative treatment for patients with CTEPH, particularly those ineligible for PEA. Procedural refinements have significantly improved safety and efficacy. However, challenges remain, including the standardization of decision-making processes for management and the establishment of optimal treatment goals. Ongoing research continues to refine the role of BPA to improve outcomes and enhance the quality of life for patients with CTEPH. (Figure presented.).

Original languageEnglish
Pages (from-to)563-573
Number of pages11
JournalExpert Review of Respiratory Medicine
Volume19
Issue number6
DOIs
Publication statusPublished - 2025
Externally publishedYes

Keywords

  • Balloon pulmonary angioplasty
  • chronic thromboembolic pulmonary hypertension
  • combination therapy
  • pulmonary endarterectomy
  • pulmonary hypertension targeted medications

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