Outcomes Associated With Catheter-Directed Therapies in Chronic Thromboembolic Pulmonary Hypertension

Background

Catheter-directed therapies (CDTs) for acute pulmonary embolism (PE) are becoming increasingly popular. Although potentially beneficial in acute PE, CDT is ineffective for chronic thromboembolic disease. Herein we present our experience of patients with subsequently confirmed chronic thromboembolic pulmonary hypertension (CTEPH) or pulmonary artery sarcoma who initially received CDT before referral for surgical intervention.

Research Question

How often is CDT being used in patients with CTEPH or pulmonary artery tumor, and what are the associated outcomes?

Study Design and Methods

Retrospective review of all pulmonary thromboendarterectomy surgeries performed at the University of California, San Diego, from January 1, 2020, through December 31, 2021.

Results

Three hundred fifty-four pulmonary thromboendarterectomy surgeries were performed during the study period. Fifty-two patients received CDT before referral (15%). Before CDT attempt, duration of dyspnea ranged from 3 days to 10 years and mean right ventricular systolic pressure measured by echocardiography was 75 ± 23 mm Hg. After CDT, mean right ventricular systolic pressure was 77 ± 23 mm Hg. Three patients reported full recovery of symptoms, 23 patients reported some improvement, and 26 patients reported no change in symptoms. Imaging at time of CDT was available for review for 32 patients; 23 patients showed radiologic evidence of CTEPH and three patients showed evidence suspicious of sarcoma. Complications associated with CDT occurred in seven patients (13%) and included one death.

Interpretation

Radiologic signs of CTEPH frequently were overlooked at the time of CDT. Most patients (94%) achieved minimal or no improvement in symptoms after CDT, and 13% experienced complications. It is important to assess for clinical and radiologic signs of CTEPH when considering CDT in presumed acute PE to minimize unnecessary risk and instead refer patients for CTEPH evaluation.