Percutaneous BPA is an emerging interventional “keyhole” technique for patients with inoperable CTEPH. Occluded pulmonary vessels are dilated through the insertion and inflation of a small balloon.1
BPA should only be performed in an expert center in the management of CTEPH.2
To reduce the risk of complications and achieve therapeutic benefit, this procedure is generally:2,3
* repeated several times (4–6 sessions per patient, at 2–8-week intervals) and
* performed in multiple vessel locations during each session.
* Improvement in pulmonary hemodynamics, symptoms, and functional capacity seen in eight observational studies (considered moderate-quality evidence) of BPA.
* Complications include mortality resulting from the procedure, perforation, aneurysm, reperfusion pulmonary edema, hemoptysis/hemosputum, wire injury, vessel dissection, vessel rupture, pulmonary parenchymal bleeding and hemorrhagic pleural effusions.
* Acute mortality (<30 days post-BPA) ranges from 1.4% to 10%.
Use of targeted medical therapy alongside BPA is common practice and can stabilize patient hemodynamics and improve right heart function.
The RACE (Riociguat versus balloon pulmonary Angioplasty in non-operable Chronic thromboEmbolic pulmonary hypertension) trial (NCT 02634203) is evaluating the safety and efficacy of riociguat versus BPA in patients with non-operable CTEPH.5
1. Gall H et al. Eur Respir Rev 2017;26:160121. 2.Lang I et al. Eur Respir Rev 2017;26:160119. 3.National Health Service (NHS) England. Clinical Commissioning Policy: Balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension (all ages). Available at: https://www.england.nhs.uk/wp-content/uploads/2018/04/ccp-balloon-pulmonary-angioplasty-for-ctph.pdf (accessed August 2018). 4.Phan K et al. Heart Lung Circ 2018;27:89–98. 5.US National Library of Medicine. ClincialTrials.gov. Riociguat Versus Balloon Pulmonary Angioplasty in Non-operable Chronic thromboEmbolic Pulmonary Hypertension (RACE). NCT02634203. Available at: https://clinicaltrials.gov/ct2/show/NCT02634203 (accessed August 2018).