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Balloon Pulmonary Angioplasty — EECC MCQ

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ModeratePulmonary Vascular DiseaseBalloon Pulmonary AngioplastyEECC

A 58-year-old man with CTEPH is assessed at a specialist PH centre. His anatomy shows predominantly distal subsegmental disease not amenable to pulmonary endarterectomy. What interventional option is available?

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Correct answer: D — Balloon pulmonary angioplasty (BPA) — a catheter-based technique using serial balloon dilations of stenosed/occluded segmental and subsegmental pulmonary arteries; appropriate for inoperable CTEPH or residual PH after PEA

Balloon pulmonary angioplasty (BPA) has transformed the management of inoperable CTEPH. It involves selective catheterisation and balloon dilation of stenosed/occluded segmental and subsegmental pulmonary arteries, performed in staged sessions (typically 3-6 sessions). The 2022 ESC/ERS PH Guidelines recommend BPA for: (1) inoperable CTEPH (anatomy not suitable for PEA — distal disease); (2) residual PH after PEA; (3) patients who decline PEA. BPA has demonstrated significant improvement in haemodynamics (mPAP, PVR), functional capacity, and BNP, with acceptable complication rates (reperfusion pulmonary injury in 2-5%, improving with operator experience). It should be performed at expert CTEPH centres. Medical therapy with riociguat (CHEST trials) is used adjunctively or for patients not suitable for any interventional approach. The multimodal approach (PEA + BPA + riociguat) provides comprehensive treatment options.

Reference: ESC/ERS (2022): PH Guidelines