Balloon Pulmonary Angioplasty for Takayasu Arteritis and Peripheral Pulmonary Artery Stenosis Mimicking Chronic Thromboembolic Pulmonary Hypertension

Abstract

Balloon pulmonary angioplasty (BPA) has been reported to be effective and safe to an acceptable level in patients with distal-type, inoperable chronic thromboembolic pulmonary hypertension (CTEPH), resulting in improved long-term survival. However, evidenced treatment options and strategy including medical therapy of antithrombotic therapy, glucocorticoids, immunosuppressants, and pulmonary hypertension (PH)-specific therapies are scarce in patients with significant PH and right heart failure associated with Takayasu arteritis and peripheral pulmonary artery stenosis, both of which mimic CTEPH. Moreover, there has been still concern on safety and lack of established methodology in performing BPA for these conditions. In this report, we would like to review recent publications including several case reports and discuss the efficacy, safety, and suitable methods of BPA in this population.

Pulmonary Hypertension in Connective Tissue Diseases Other than Systemic Sclerosis

“…In addition to lifelong therapeutic anticoagulation, therapeutic considerations include surgical or procedural interventions such as pulmonary endarterectomy 117 and balloon pulmonary angioplasty, 118,119 the latter of which has demonstrated efficacy in small studies of patients with Group 4 PH associated with Takayasu's arteritis. 120 Furthermore, drugs approved for PAH have demonstrated clinical improvements in patients with inoperable CTEPH and/or persistent/ recurrent PH post-PEA. [121][122][123] Presently, the available literature guiding treatment of Group 4 PH is largely limited to CTEPH patients.…”