BACKGROUND/ OBJECTIVES: 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.
BACKGROUND/ OBJECTIVES: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: Christian Schoenfeld; Jan B Hinrichs; Karen M Olsson; Martin-Alexander Kuettner; Julius Renne; Till Kaireit; Christoph Czerner; Frank Wacker; Marius M Hoeper; Bernhard C Meyer; Jens Vogel-Claussen Journal: Eur Radiol Date: 2018-10-11 Impact factor: 5.315
Authors: Sabine K Maschke; Julius Renne; Thomas Werncke; Karen M Olsson; Marius M Hoeper; Frank K Wacker; Bernhard C Meyer; Jan B Hinrichs Journal: Eur Radiol Date: 2017-03-30 Impact factor: 5.315
Authors: Sabine K Maschke; Jan B Hinrichs; Julius Renne; Thomas Werncke; Hinrich M B Winther; Kristina I Ringe; Karen M Olsson; Marius M Hoeper; Frank K Wacker; Bernhard C Meyer Journal: Eur Radiol Date: 2018-09-12 Impact factor: 5.315
Authors: Marek Roik; Dominik Wretowski; Maciej Kostrubiec; Olga Dzikowska-Diduch; Andrzej Łabyk; Katarzyna Irzyk; Barbara Lichodziejewska; Anna Wyzgał; Krzysztof Jankowski; Piotr Pruszczyk Journal: Postepy Kardiol Interwencyjnej Date: 2016-11-17 Impact factor: 1.426
Authors: Andrzej Labyk; Dominik Wretowski; Sabina Zybińska-Oksiutowicz; Aleksandra Furdyna; Katarzyna Ciesielska; Dorota Piotrowska-Kownacka; Olga Dzikowska -Diduch; Barbara Lichodziejewska; Andrzej Biederman; Piotr Pruszczyk; Marek Roik Journal: BMC Pulm Med Date: 2018-08-16 Impact factor: 3.317