Balloon pulmonary angioplasty
Balloon pulmonary angioplasty is an emerging minimally invasive procedure to treat chronic thromboembolic pulmonary hypertension in people who are not suitable for pulmonary thromboendarterectomy or still have residual pulmonary hypertension and areas of narrowing in the pulmonary arterial tree following previous PTE.
The procedure uses balloons to open pulmonary arteries that have been narrowed or blocked by webs, bands and fibrous tissue and therefore restores blood flow to the lungs, reduces shortness of breath, and improves exercise tolerance. More data on its safety and effectiveness are still required.
Medical uses
BPA may be considered in people with symptomatic CTEPH who are not suitable for surgery. PTE is an established treatment for CTEPH but is only performed at a few specialist centres, requires surgical competence and intermittent total circulatory arrest under deep hypothermia. However, co-existing illnesses and inaccessible clots may contraindicate performing the operation. Up to 40% of those diagnosed with CTEPH are considered ineligible for surgery. Selection criteria may vary between centres.Technique
BPA is performed by specialists in a catheterization laboratory. Each procedure takes between two and four hours and most people undergo up to six treatments with the first two sessions being performed a fortnight apart and subsequent treatments being individually tailored upon follow-up assessment.A local anesthetic and moderate sedation are used but a general anaesthetic is not required, hence the person remains awake throughout the procedure. After inserting the catheter into the vein of the neck or groin, a hollow tube is introduced through the catheter and passed to the affected blocked lung arteries.
X-rays and pressures in the narrowed arteries are assessed by the specialist team before a thin wire with a deflated balloon is guided through the blood vessels to the site of blockage, where the balloon is then inflated. This mainly disrupts the organised thrombus and to a lesser degree presses it against the walls of the arteries. This increases the size of the lumen of the arteries, thus opening them and allowing the blood flow to be restored. The balloon is then deflated and removed. A number of arteries can be treated during each BPA procedure.
Recovery and follow-up
One overnight stay in hospital is usually required. This is followed by a check up appointment within three months.The overall survival has been shown to be comparable with PTE and better than with medication only.