title: Refined balloon pulmonary angioplasty driven by combined assessment of intra-arterial anatomy and physiology--Multimodal approach to treated lesions in patients with non-operable distal chronic thromboembolic pulmonary hypertension--Technique, safety and efficacy of 50 consecutive angioplasties.
abstract: OBJECTIVE
  Balloon pulmonary angioplasty (BPA) is an emerging therapeutic method in CTEPH. We aimed to prove the safety and efficacy of refined BPA driven by combined assessment of intra-arterial anatomy (IVUS/OCT) and physiology (pulmonary pressure ratio, PPR) in non-operable distal CTEPH.
  
  
  METHODS
  11 pts (mean age 76, 59–84, 7 males) were enrolled in the BPA program according to the following inclusion criteria: 1. Non-operable CTEPH; 2. RHC with mPAP > 30 mm Hg; 3. At least one segmental perfusion defect at lung scintigraphy; 4. WHO class > II. Overall, 9 pts underwent 27 BPA sessions (mean 3 sessions per patient, range 1–5), 50 pulmonary arteries were dilated (mean 6 vessels per patient, range 3–9; 2.03 dilated arteries per session). All the angioplasties were performed according to an algorithm, which incorporated anatomical and functional assessment of targeted lesions.
  
  
  RESULTS
  We performed BPA of 32 web lesions, 5 ring-like stenosis and 13 complete obstructions. BPA resulted in clinical and hemodynamic improvement. WHO class improved from pre-BPA to post-BPA (p = 0.018), and 6 MWD increased from 304 m to 384 m (p = 0.03), NT-proBNP dropped from 1248 pg/ml to 730 pg/ml (p < 0.001). Mean PAP and PVR decreased (p = 0.01), while CO and CI increased (p = 0.01). All dilated arteries were patent at angiographic reassessment. No significant complications occurred and all treated patients are still alive. Insignificant transient reperfusion pulmonary oedema occurred in only 2 patients, who responded well to supplemental oxygen.
  
  
  CONCLUSIONS
  Refined BPA with assessment of intrapulmonary physiology using a pressure wire and precise evaluation of anatomy with IVUS and OCT provides hemodynamic and functional improvement, with minimal complications in distal non-operable CTEPH. This observation requires further validation in a large prospective study.
authors.affiliation: Department of Internal Medicine and Cardiology, Medical University of Warsaw, Poland. Electronic address: mroik@wum.edu.pl.
authors.forename: Marek
authors.initials: M
authors.lastname: Roik
authors.affiliation: Department of Internal Medicine and Cardiology, Medical University of Warsaw, Poland.
authors.forename: Dominik
authors.initials: D
authors.lastname: Wretowski
authors.affiliation: Department of Internal Medicine and Cardiology, Medical University of Warsaw, Poland.
authors.forename: Andrzej
authors.initials: A
authors.lastname: Łabyk
authors.affiliation: Department of Internal Medicine and Cardiology, Medical University of Warsaw, Poland.
authors.forename: Maciej
authors.initials: M
authors.lastname: Kostrubiec
authors.affiliation: Department of Internal Medicine and Cardiology, Medical University of Warsaw, Poland.
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Irzyk
authors.affiliation: Department of Internal Medicine and Cardiology, Medical University of Warsaw, Poland.
authors.forename: Olga
authors.initials: O
authors.lastname: Dzikowska-Diduch
authors.affiliation: Department of Internal Medicine and Cardiology, Medical University of Warsaw, Poland.
authors.forename: Barbara
authors.initials: B
authors.lastname: Lichodziejewska
authors.affiliation: Department of Internal Medicine and Cardiology, Medical University of Warsaw, Poland.
authors.forename: Michał
authors.initials: M
authors.lastname: Ciurzyński
authors.affiliation: Department of Internal Medicine and Cardiology, Medical University of Warsaw, Poland.
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Kurnicka
authors.affiliation: 1st Department of Radiology, Medical University of Warsaw, Poland.
authors.forename: Marek
authors.initials: M
authors.lastname: Gołębiowski
authors.affiliation: Department of Internal Medicine and Cardiology, Medical University of Warsaw, Poland.
authors.forename: Piotr
authors.initials: P
authors.lastname: Pruszczyk
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000379:methods*; D002908:Chronic Disease; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D011446:Prospective Studies; D011655:Pulmonary Embolism / Q000150:complications / Q000175:diagnosis / Q000628:therapy*
keywords: Balloon pulmonary angioplasty; Chronic thromboembolic pulmonary hypertension; Efficacy; Multimodality (PPR/OCT/IVUS); Safety