Balloon pulmonary angioplasty may be ‘life-changing’ for CTEPH patients
Most experience improvements in exercise capacity and quality of life, study finds
Balloon pulmonary angioplasty, or BPA, can be an effective treatment for chronic thromboembolic pulmonary hypertension (CTEPH), a new study highlights.
“Patients treated with BPA experienced improvement in functional class and exercise capabilities, with relatively low rates of procedure-related complications,” researchers wrote.
The study, “Refined Balloon Pulmonary Angioplasty in Chronic Thromboembolic Pulmonary Hypertension: Initial Results of US Regional Program,” was published in the journal JACC: Advances.
BPA is promising CTEPH treatment especially when surgery is not an option
CTEPH is a form of pulmonary hypertension that is caused by blood clots in the lung’s blood vessels, leading to increased pressure in these vessels.
Standard treatment for CTEPH is surgery, but for patients who are not eligible for surgery or for whom surgery is not effective, BPA has emerged in recent years as a promising treatment option. BPA uses a catheter to thread a tiny uninflated balloon into the blood vessel, then when the balloon is inflated, it can help to break up the disease-driving clots.
A team led by scientists at Temple University, in Pennsylvania, reported on outcomes for all CTEPH patients who had been treated with BPA at their institution from 2015 to 2022.
“This single center observational study represents one of the largest, reported experiences of American patients treated with BPA,” the scientists noted.
The study included 77 people with CTEPH, who underwent a total of 211 BPA procedures, with an average of just under three procedures per patient. The mean age was 62 years, a little more than half were female, and around two-thirds were taking medications to help address their CTEPH. About a quarter of the participants had previously undergone surgery for CTEPH; the rest were considered mainly unsuited or high-risk for surgery.
More than 80% of the patients completed their BPA sessions — meaning they had achieved their clinical goals, were not expected to make further improvements, or refused further BPA sessions. The remaining 15 patients were still undergoing BPA sessions when the study was put together.
CTEPH patients treated with balloon pulmonary angioplasty come away having fewer symptoms, and some may be able to come off medications altogether.
Results indicate improvements in blood flow, heart function, walking capacity
Results showed that pulmonary vascular resistance — a measure of internal resistance to blood flow within the lung’s blood vessels — decreased significantly following BPA. Levels of B-type natriuretic peptide, a marker of heart damage, also decreased, and available data from heart imaging tests suggested improved heart function.
Meanwhile, the distance that patients were able to walk in six minutes increased after the procedure, by an average of 71.7 meters (more than 230 feet). Patients’ WHO functional class, a general measure of disease symptoms, improved by an average of one class.
This level of improvement is “promising, and at times life-changing, particularly in the young and physically active patients,” the researchers wrote.
Statistical models showed that improvements tended to be more pronounced among patients who received more BPA sessions and those who were on Adempas (riociguat) prior to BPA.
Medication use did not change substantially following BPA, though the researchers noted that, of 15 patients who had been on oxygen therapy, seven no longer required oxygen after undergoing BPA.
“Almost half of the patients that were on home oxygen were able to come off oxygen, which can dramatically improve the quality of life in these patients,” the team wrote.
Patients experienced ‘markedly improved exercise capacity and quality of life’
“Our study showed that opening up blockages in lung arteries of these patients markedly improved exercise capacity and quality of life,” Riyaz Bashir, MD, senior investigator of the study, said in a university press release. “CTEPH patients treated with balloon pulmonary angioplasty come away having fewer symptoms, and some may be able to come off medications altogether.”
Over an average follow-up time of more than a year after the first BPA session, a total of six deaths were recorded among these patients. Five were unrelated to CTEPH, and included causes like motor vehicle accident, recreational drug overdose, and COVID-19. One patient died due to lung damage that occurred as a complication of the BPA procedure.
There were 10 BPA procedures where the patient experienced hemoptysis (coughing up blood) as a complication. This was usually mild, though in one patient it was severe enough to necessitate mechanical ventilation. Overall, rates of complications, especially bleeding that has historically been associated with BPA, were low in this study.
“With continued refinement of the procedure, we have successfully decreased bleeding rates in these patients,” Bashir said. “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.”