Cone beam CT pulmonary angiography in balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension during the program initiation period
A. Páez-Carpio , F.X. Zarco , E. Serrano , I. Vollmer , J. Puig , J.A. Barberà , F.M. Gómez , I. Blanco
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引用次数: 0
Abstract
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.
期刊介绍:
Clinical Radiology is published by Elsevier on behalf of The Royal College of Radiologists. Clinical Radiology is an International Journal bringing you original research, editorials and review articles on all aspects of diagnostic imaging, including:
• Computed tomography
• Magnetic resonance imaging
• Ultrasonography
• Digital radiology
• Interventional radiology
• Radiography
• Nuclear medicine
Papers on radiological protection, quality assurance, audit in radiology and matters relating to radiological training and education are also included. In addition, each issue contains correspondence, book reviews and notices of forthcoming events.