‘Key improvements’ with balloon pulmonary angioplasty for chronic blood clots in lungs
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Key takeaways:
- Balloon pulmonary angioplasty improved exercise capacity and quality of life in patients with chronic thromboembolic pulmonary hypertension (CTEPH).
- The procedure could be an option for inoperable CTEPH.
For patients with chronic thromboembolic pulmonary hypertension, balloon pulmonary angioplasty was associated with an improvement in pulmonary hemodynamic parameters and quality of life measures, data from a single-center study show.
Balloon pulmonary angioplasty is a rapidly evolving therapeutic option for patients with nonsurgical chronic thromboembolic pulmonary hypertension (CTEPH); however, there are few U.S. studies that have reported on the outcomes of this novel therapeutic option using refined techniques, Riyaz Bashir, MD, FACC, RVT, professor of medicine and director of vascular and endovascular medicine at the Lewis Katz School of Medicine and Temple University Hospital, and colleagues wrote in JACC: Advances.
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“In patients with inoperable CTEPH, balloon pulmonary angioplasty using refined techniques is a safe and effective therapy,” Bashir told Healio. “This treatment significantly improved HF symptoms as well as 6-minute walking distance in these patients. More than half of these patients were able to come off oxygen.”
'Therapeutic option' for inoperable patients
In a retrospective chart review, Bashir and colleagues analyzed data from 77 patients with CTEPH who underwent 211 balloon pulmonary angioplasty sessions at the Temple Heart & Vascular Institute between August 2015 and May 2022 (average, 2.7 sessions per patient; mean age, 61.9 years; 51.9% women; 24.7% Black). The primary efficacy endpoint was the change in pulmonary vascular resistance after balloon pulmonary angioplasty compared with baseline measures. The primary safety endpoint was the rate of hemoptysis within 24 hours. Secondary endpoints included death, WHO functional class and 6-minute walk distance.
Within the cohort, 42.9% had inoperable CTEPH and 27.3% were determined to be at prohibitively high surgical risk due to comorbidities.
After undergoing balloon pulmonary angioplasty, the mean pulmonary vascular resistance improved by 26%, from 6.5 Wood units to 4.8 Wood units, a mean change of 1.7 (P < .001). The mean 6-minute walk distance improved by 71.7 m (P < .001), and WHO functional class improved by one functional class (P < .001).
There was one death related to reperfusion lung injury. Ten sessions (4.7%) were complicated by hemoptysis.
Independent factors associated with improved functional and hemodynamic response included preprocedural use of riociguat (Adempas, Bayer), reduced baseline pulmonary artery compliance and more than three balloon pulmonary angioplasty sessions per patient, according to the researchers.
“The main clinical implication of these findings is that those CTEPH patients who were debilitated by this disease, despite medical and surgical treatments, now have a therapeutic option that can remarkably improve their quality of life,” Bashir told Healio. “Additionally widespread availability of this therapy in U.S. can improve access to care for many of these patients, who must travel long distances to get the care they need for this lifelong disease.”
Balancing risks
Bleeding risk traditionally has been high with balloon pulmonary angioplasty.
“But with continued refinement of the procedure, we have successfully decreased bleeding rates in these patients,” Bashir said in a press release. “In doing so, we are now able to show that balloon pulmonary angioplasty is not only relatively safe but also associated with key improvements in pulmonary hypertension and functional capacity.”
Bashir said more data is needed comparing this treatment with medical therapy for patients deemed inoperable to establish the role of the therapy in clinical practice.
“The medical therapy in these patients is very expensive and many patients cannot afford it; therefore, having another treatment option will be a major advance in this space not only for patients in developed countries but also in developing world,” Bashir told Healio.
Reference:
- Balloon pulmonary angioplasty, a novel treatment for chronic blood clots in lung arteries, gives patients a new lease on life, Lewis Katz School of Medicine at Temple University study shows. Press Release. Temple University Lewis Katz School of Medicine; April 13, 2023.
For more information:
Riyaz Bashir, MD, FACC, RVT, can be reached at riyaz.bashir@tuhs.temple.edu; Twitter: @riyazbashir.
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