Balloon pulmonary angioplasty for inoperable chronic thromboembolic pulmonary hypertension

Chronic thromboembolic pulmonary hypertension (CTEPH) is one of the most common subsets of precapillary pulmonary hypertension with a prevalence of 50 individuals per million in Europe. The recent RACE study in patients who were no candidates for surgical pulmonary endarterectomy has shown that balloon pulmonary angioplasty (BPA) is superior to medical treatment alone, emphasising the mechanical disease component [1].

Primary treatment of CTEPH is surgical pulmonary endarterectomy for suitable patients, but treatment for those not eligible for surgery remains an unmet need. The RACE trial has prospectively compared the efficacy of oral riociguat, a stimulator of soluble guanylate cyclase, with BPA, an interventional technique using balloons to break intravascular obstructions and to restore flow. At 26 weeks, after randomisation of 105 patients (53 patients were assigned to riociguat and 52 were assigned to BPA), the primary endpoint geometric mean pulmonary vascular resistance decreased to 41% of baseline value in the BPA group and to 68% of baseline value in the riociguat group. The secondary endpoint (change in 6MWD at week 26) was not significant (50m in the BPA arm vs 44m in the riociguat arm).

The presenter, Dr Xavier Jaïs (University of Paris-Sud, France), pointed out that more data will become available on combination of BPA with riociguat after completing the extended 6-month follow-up where cross-overs were allowed.

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   1. Jaïs X. RCT1885, ERS 2019, 29 Sept-2 Oct, Madrid, Spain.

Posted on 28 November 201913 June 2024