Published May 1, 2025
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Cone beam CT pulmonary angiography in balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension during the program initiation period.
Authors/Creators
- 1. Department of Medical Imaging, University of Toronto, Toronto M5T 1W7, ON, Canada; Department of Radiology, CDI, Hospital Clínic Barcelona, Barcelona 08036, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona 08036, Spain; Faculty of Medicine and Health Sciences, Universitat de Barcelona, Barcelona 08036, Spain
- 2. Department of Radiology, CDI, Hospital Clínic Barcelona, Barcelona 08036, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona 08036, Spain
- 3. Department of Radiology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat 08907, Spain
- 4. Department of Radiology, Vall d'Hebron University Hospital, Barcelona 08035, Spain
- 5. Department of Radiology, CDI, Hospital Clínic Barcelona, Barcelona 08036, Spain
- 6. Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona 08036, Spain; Department of Pulmonary Medicine, Hospital Clínic Barcelona, Barcelona 08036, Spain; Biomedical Research Networking Centre on Respiratory Diseases (CIBERES), Madrid, Spain
- 7. Department of Radiology, Hospital Universitari i Politècnic La Fe, València 46026, Spain
Description
AIM: Cone beam CT pulmonary angiography (CBCT-PA) has proven to be a valuable technique during balloon pulmonary angioplasty (BPA) for chronic thromboembolic pulmonary hypertension (CTEPH) in established centres. This study aimed to demonstrate the safety and efficacy of CBCT-PA-guided BPA for CTEPH during the initial period of a BPA program. CBCT-PA improves procedural accuracy by visualising distal thromboembolic lesions and providing real-time guidance, which is critical during program initiation. MATERIALS AND METHODS: This single-centre, single-arm study prospectively evaluated patients with CTEPH undergoing BPA from 2017 to 2022. Outcomes of interest included pre-BPA and post-BPA 6-minute walking distance, New York Heart Association Functional Classification (NYHA-FC), mean pulmonary artery pressure (mPAP), pulmonary vascular resistance (PVR), N-terminal pro B-type natriuretic peptide (NT-proBNP), and BPA-related adverse events (AEs). Statistical analysis compared pre-BPA and post-BPA results. CBCT-PA was used for three-dimensional (3D) vascular mapping and precise lesion targeting. RESULTS: Ninety BPA sessions were performed on 19 patients under CBCT-PA guidance. Significant improvements were observed in mPAP (37.0 mmHg [interquartile range (IQR): 28.0-46.0] vs 25.5 [IQR: 22.8-31.5]; P<0.001), PVR (5.5 Wood units [IQR: 3.4-8.5] vs 3.3 [IQR: 2.7-4.6]; P < 0.001), NYHA-FC I-II rate (8 [42%] vs 18 [94%]; P = 0.04), and NT-proBNP (165 pg/mL [IQR: 82-1146] vs 127.0 [IQR: 57-216]; P = 0.014). Overall AE rate was 14.4%, and major AE rate was 7.7% (all Cardiovascular and Interventional Radiology Society of Europe [CIRSE] grade 3). The haemoptysis rate was 4.4%. No periprocedural deaths were reported. CONCLUSION: BPA performed under CBCT-PA guidance appeared to be an effective and safe approach in the program's initial period, helping achieving similar results as established centres.
Copyright © 2025 The Author(s). Published by Elsevier Ltd.. All rights reserved.
Notes
In loving memory of Alejandro P\u00E1ez-Carpio, MD. Editorial assistance, in the form of language editing and correction, as well as consulting regarding the statistical analysis was provided by XpertScientific Editing and Consulting Services. The authors wish to acknowledge the invaluable contribution of all Hospital Cl\u00EDnic Barcelona Pulmonary Hypertension Multidisciplinary Team members. The authors wish to acknowledge the valuable contribution of the following scientific societies: Sociedad Espa\u00F1ola de Neumolog\u00EDa y Cirug\u00EDa Tor\u00E1cica (SEPAR)\u2014Societat Catalana de Pneumologia (SOCAP)\u2014Fundaci\u00F3n contra la Hipertensi\u00F3n Pulmonar (FCHP)\u2014Sociedad Espa\u00F1ola de Radiolog\u00EDa M\u00E9dica (SERAM).