Lang Irene, Meyer Bernhard C, Ogo Takeshi, Matsubara Hiromi, Kurzyna Marcin, Ghofrani Hossein-Ardeschir, Mayer Eckhard, Brenot Philippe
Dept of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
Dept of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany.
Eur Respir Rev. 2017 Mar 29;26(143). doi: 10.1183/16000617.0119-2016. Print 2017 Mar 31.
Chronic thromboembolic pulmonary hypertension (CTEPH) is thought to result from incomplete resolution of pulmonary thromboemboli that undergo organisation into fibrous tissue within pulmonary arterial branches, filling pulmonary arterial lumina with collagenous obstructions. The treatment of choice is pulmonary endarterectomy (PEA) in CTEPH centres, which has low post-operative mortality and good long-term survival. For patients ineligible for PEA or who have recurrent or persistent pulmonary hypertension after surgery, medical treatment with riociguat is beneficial. In addition, percutaneous balloon pulmonary angioplasty (BPA) is an emerging option, and promises haemodynamic and functional benefits for inoperable patients. In contrast to conventional angioplasty, BPA with undersized balloons over guide wires exclusively breaks intraluminal webs and bands, without dissecting medial vessel layers, and repeat sessions are generally required. Observational studies report that BPA improves haemodynamics, symptoms and functional capacity in patients with CTEPH, but controlled trials with long-term follow-up are needed. Complications include haemoptysis, wire injury, vessel dissection, vessel rupture, reperfusion pulmonary oedema, pulmonary parenchymal bleeding and haemorrhagic pleural effusions. This review summarises the available evidence for BPA, patient selection, recent technical refinements and periprocedural imaging, and discusses the potential future role of BPA in the management of CTEPH.
慢性血栓栓塞性肺动脉高压（CTEPH）被认为是由于肺动脉分支内的肺血栓栓塞未完全溶解，血栓组织化为纤维组织，导致肺动脉管腔被胶原性阻塞物填充所致。在CTEPH治疗中心，首选的治疗方法是肺动脉内膜剥脱术（PEA），该手术术后死亡率低，长期生存率良好。对于不符合PEA手术条件或术后出现复发或持续性肺动脉高压的患者，使用利奥西呱进行药物治疗有益。此外，经皮球囊肺动脉成形术（BPA）是一种新兴的治疗选择，有望为无法手术的患者带来血流动力学和功能方面的益处。与传统血管成形术不同，通过导丝使用尺寸较小的球囊进行BPA仅能破坏腔内的纤维网和束带，而不会剥离血管中层，通常需要多次手术。观察性研究报告称，BPA可改善CTEPH患者的血流动力学、症状和功能能力，但仍需要进行长期随访的对照试验。并发症包括咯血、导丝损伤、血管夹层、血管破裂、再灌注肺水肿、肺实质出血和出血性胸腔积液。本综述总结了关于BPA的现有证据、患者选择、近期技术改进和围手术期成像，并讨论了BPA在CTEPH管理中未来可能发挥的作用。
