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Abstract：
In this article, we discuss the topic of chronic thromboembolic pulmonary disease (CTEPD) and the growing role of balloon pulmonary angioplasty (BPA) in its treatment. We present the pathophysiology of CTEPD which arises from an incomplete resolution of thrombi in the pulmonary arteries and leads to stenosis and occlusion of the vessels. The article focuses mainly on the chronic thromboembolic pulmonary hypertension (CTEPH) subpopulation for which prognosis is very poor when left untreated. We describe a multimodal approach to treating CTEPH, including pulmonary endarterectomy (PEA), BPA, and pharmacological therapies. Additionally, the benefits of pharmacological pre-treatment before BPA and the technical aspects of the procedure itself are outlined. It is emphasized that BPA does not replace PEA but serves as a complementary treatment option for eligible patients. We summarized efficacy and treatment goals including an improvement in functional and biochemical parameters before and after BPA. Patients who received pre-treatment with riociguat prior to BPA exhibited a notable reduction in the occurrence of less severe complications. However, elderly patients are still perceived as an especially vulnerable group. It is shown that the prognosis of patients undergoing BPA is similar to PEA in the first years after the procedure but the long-term prognosis of BPA still remains unclear. The 2022 ESC/ERS guidelines highlight the significant role of BPA in the multimodal treatment of CTEPH, emphasizing its effectiveness and recommending its consideration as a therapeutic option for patients with CTEPD, both with and without pulmonary hypertension. This review summarizes the available evidence for BPA, patient selection, procedural details, and prognosis and discusses the potential future role of BPA in the management of CTEPH.
摘要：
在这篇文章中,我们讨论了慢性血栓栓塞性肺疾病（CTEPD）的主题以及球囊肺血管成形术（BPA）在其治疗中的日益重要的作用。我们介绍了CTEPD的病理生理学，该病理生理学是由肺动脉血栓的不完全消退引起的，并导致血管狭窄和闭塞。本文主要关注慢性血栓栓塞性肺动脉高压（CTEPH）亚群，如果不治疗，其预后非常差。我们描述了一种治疗CTEPH的多模式方法，包括肺内膜切除术（PEA），BPA,和药物治疗。此外,概述了在BPA之前进行药物预处理的益处以及该程序本身的技术方面。需要强调的是，BPA不能替代PEA，但可以作为符合条件的患者的补充治疗方案。我们总结了疗效和治疗目标，包括BPA前后功能和生化参数的改善。在BPA之前接受riociguat预处理的患者显着减少了严重并发症的发生率。然而,老年患者仍然被认为是一个特别脆弱的群体。研究表明，在手术后的第一年，接受BPA的患者的预后与PEA相似，但BPA的长期预后仍不清楚。2022年ESC/ERS指南强调了BPA在CTEPH的多模式治疗中的重要作用，强调其有效性，并建议将其作为CTEPD患者的治疗选择，有和没有肺动脉高压。这篇综述总结了BPA的现有证据，患者选择,程序细节,和预后，并讨论了BPA在CTEPH管理中的潜在未来作用。
