From the Departments of Radiology (S.H., H.H., T.N., Y.O., T.F.) and Cardiovascular Medicine (T.A., J.U., A.T., T.O.), National Cerebral and Cardiovascular Center, 6-1 Kishibeshinmachi, Suita, Osaka 564-8565, Japan; and Department of Diagnostic Radiology, Tohoku University Hospital, Sendai, Japan (S.H., H.O.).
Radiographics. 2022 Oct;42(6):1881-1896. doi: 10.1148/rg.210102.
Chronic thromboembolic pulmonary hypertension (CTEPH), which is classified as group 4 pulmonary hypertension (PH) in the 2015 European Society of Cardiology/European Respiratory Society guidelines for the diagnosis and treatment of PH, is regarded as a complication of pulmonary embolism and is caused by the transformation of incompletely resolved thrombi into fibrous tissue that occludes the pulmonary arteries. The current established reference standard curative therapy for CTEPH is pulmonary endarterectomy (PEA), which provides good long-term outcomes with a low mortality rate. For patients with inoperable disease with inaccessible lesions and risk factors for surgery or patients who are diagnosed with residual or recurrent PH after PEA, medical therapy with riociguat is recommended. Balloon pulmonary angioplasty (BPA) is an emerging alternative treatment option for patients with inoperable disease or those with residual or recurrent PH after PEA. BPA has been reported to improve hemodynamics, cardiac function, exercise capacity, and symptoms, as well as PEA. A detailed assessment of thromboembolic lesions in pulmonary arteries by using multiple imaging techniques and treatment strategies with multiple staged procedures based on the patient's condition is important for safe and effective BPA. However, this new technique may still induce life-threatening complications, such as reperfusion pulmonary edema, wire perforation, vessel dissection, and vessel rupture. Meticulous attention to technique is mandatory to minimize serious complications owing to the nature of the anatomic territory involved. The authors summarize the current roles, goals, and complications of BPA in patients with CTEPH and demonstrate ways to formulate an effective and safe treatment strategy. The future perspective of BPA is also discussed. RSNA, 2022.
慢性血栓栓塞性肺动脉高压（CTEPH）在 2015 年欧洲心脏病学会/欧洲呼吸学会肺动脉高压诊断和治疗指南中被归类为第 4 组肺动脉高压（PH），被认为是肺栓塞的一种并发症，是由不完全溶解的血栓转化为纤维组织阻塞肺动脉引起的。目前 CTEPH 的既定标准治疗方法是肺动脉内膜切除术（PEA），其提供了良好的长期结果，死亡率低。对于无法手术的疾病患者，病变无法到达，存在手术风险因素，或 PEA 后诊断为残余或复发 PH 的患者，建议采用 riociguat 进行药物治疗。球囊肺动脉成形术（BPA）是一种新兴的不可手术疾病或 PEA 后残余或复发 PH 的替代治疗选择。据报道，BPA 可改善血流动力学、心功能、运动能力和症状，以及 PEA。通过使用多种成像技术对肺动脉内的血栓栓塞病变进行详细评估，并根据患者的情况采用多阶段治疗策略进行治疗，对于 BPA 的安全有效非常重要。然而，这种新技术可能仍然会引起危及生命的并发症，如再灌注肺水肿、导丝穿孔、血管夹层和血管破裂。由于所涉及的解剖区域的性质，必须谨慎注意技术，以最大限度地减少严重并发症。作者总结了 BPA 在 CTEPH 患者中的当前作用、目标和并发症，并展示了制定有效和安全治疗策略的方法。还讨论了 BPA 的未来展望。RSNA，2022 年。
