title: Efficacy and safety of balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension guided by cone-beam computed tomography and electrocardiogram-gated area detector computed tomography.
abstract: BACKGROUND
  Chronic thromboembolic pulmonary hypertension (CTEPH) is a disease characterized by chronic obstructive thrombus and pulmonary hypertension. Balloon pulmonary angioplasty (BPA), an emerging alternative catheter-based treatment for inoperable patients with CTEPH, has not yet been standardised, especially for lesion assessment in distal pulmonary arteries. Recent advancement in computed tomography enables distal CTEPH lesions to be visualized.
  
  
  METHODS
  We retrospectively studied 80 consecutive patients with inoperable CTEPH who received BPA guided by cone-beam computed tomography (CT) (CBCT) or electrocardiogram (ECG)-gated area detector CT (ADCT) for target lesion assessment. We collected clinical and hemodynamic data, including procedural complications, before BPA and at 3 months and 1year after BPA.
  
  
  RESULTS
  Three hundred eight-five BPA sessions (4.8 sessions/patient) were performed for the lesions of subsegmental arteries (1155 lesions), segmental arteries (738 lesions), and lobar arteries (4 lesions) identified by CBCT or ECG-gated ADCT. Significant improvements in the symptoms, 6-min walk distance, brain natriuretic peptide level, exercise capacity, and haemodynamics were observed 3 months and 1year after BPA. No cases of death or cardiogenic shock with a low rate of severe wire perforation (0.3%) and severe reperfusion oedema (0.3%) were observed.
  
  
  CONCLUSIONS
  BPA guided by CBCT or ECG-gated ADCT is effective and remarkably safe in patients with CTEPH . These new advanced CT techniques may be useful in pre-BPA target lesion assessment.
authors.affiliation: Division of Pulmonary Circulation, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Centre, Osaka, Japan; Department of Advanced Mediccal Research for Pulmonary Hypertension, National Cerebral and Cardiovascular Centre, Osaka, Japan. Electronic address: ogo.takeshi.hp@mail.ncvc.go.jp.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Ogo
authors.affiliation: Department of Radiology, National Cerebral and Cardiovascular Centre, Osaka, Japan.
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Fukuda
authors.affiliation: Division of Pulmonary Circulation, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Centre, Osaka, Japan.
authors.forename: Akihiro
authors.initials: A
authors.lastname: Tsuji
authors.affiliation: Division of Pulmonary Circulation, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Centre, Osaka, Japan.
authors.forename: Shigefumi
authors.initials: S
authors.lastname: Fukui
authors.affiliation: Division of Pulmonary Circulation, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Centre, Osaka, Japan.
authors.forename: Jin
authors.initials: J
authors.lastname: Ueda
authors.affiliation: Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Centre, Osaka, Japan.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Sanda
authors.affiliation: Department of Radiology, National Cerebral and Cardiovascular Centre, Osaka, Japan.
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Morita
authors.affiliation: Division of Pulmonary Circulation, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Centre, Osaka, Japan.
authors.forename: Ryotaro
authors.initials: R
authors.lastname: Asano
authors.affiliation: Division of Pulmonary Circulation, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Centre, Osaka, Japan.
authors.forename: Nao
authors.initials: N
authors.lastname: Konagai
authors.affiliation: Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Centre, Osaka, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Yasuda
mesh_terms: D000368:Aged; D000800:Angioplasty, Balloon / Q000379:methods*; D002908:Chronic Disease; D054893:Cone-Beam Computed Tomography / Q000379:methods; D004562:Electrocardiography; D005260:Female; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D006976:Hypertension, Pulmonary / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011651:Pulmonary Artery / Q000000981:diagnostic imaging; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D012189:Retrospective Studies; D025321:Surgery, Computer-Assisted / Q000379:methods; D013923:Thromboembolism / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D013927:Thrombosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology; D014057:Tomography, X-Ray Computed / Q000379:methods
keywords: Balloon pulmonary angioplasty; Chronic thromboembolic pulmonary hypertension; Cone-beam computed tomography; ECG-gated area detector computed tomography