Flow Grade-Based Success Rates, Complication Rates, and Balloon Pulmonary Angioplasty Patency for Total Occlusions

The number of successfully recanalized total occlusions affects hemodynamic improvement after balloon pulmonary angioplasty (BPA) in patients with chronic thromboembolic pulmonary hypertension (CTEPH). We aimed to clarify the current efficacy, patency, and success rate of BPA for total occlusions. Between April 2016 and August 2021, 178 BPAs were performed in 100 patients with CTEPH and total occlusions. The primary success and subsequent patency rates immediately before the second BPA procedure (follow-up) were compared between the segmental and subsegmental groups, based on the flow grade, which was defined as follows: 0, no reperfusion; 1, minimal reperfusion; 2, partial reperfusion; and 3, complete reperfusion. Total occlusions were mainly located in the right lung (70%) and lower lobes (48%). The primary success rate was 88%, with significant improvements in oxygenation, hemodynamic parameters, and 6-minute walk test. The primary flow grade did not differ between groups. However, the proportion of lesions with a flow grade of 2 or 3 at follow-up was significantly higher in the subsegmental group than in the segmental group (84% vs 45%, respectively; P < 0.01). In multivariate analysis, flow grade in the acute phase (odds ratio [OR], 46.9; 95% confidence interval [CI], 12.54-176.78; P < 0.01) and subsegmental lesions (OR, 13.8; 95% CI, 3.24-58.94; P < 0.01) were independently associated with better patency (flow grade of 2 or 3) at follow-up. Total occlusions can be safely and effectively treated with BPA. BPA for total occlusions may be preferable for subsegmental over segmental lesions. Le nombre d'occlusions totales recanalisées avec succès a un impact sur l'amélioration hémodynamique après une angioplastie pulmonaire par ballonnet (APB) chez les patients atteints d'hypertension pulmonaire thromboembolique chronique (HPTC). Notre objectif était de clarifier l'efficacité actuelle, la perméabilité et le taux de succès de l'APB pour les occlusions totales. Entre avril 2016 et août 2021, 178 APB ont été réalisées chez 100 patients atteints d'HPTC et d'occlusions totales. Les taux de succès primaire et de perméabilité subséquente immédiatement avant une seconde procédure d'APB (suivi clinique) ont été comparés entre les groupes segmentaires et sous-segmentaires en fonction du grade de flux, défini comme suit : 0, pas de reperfusion; 1, reperfusion minimale; 2, reperfusion partielle; et 3, reperfusion complète. Les occlusions totales étaient principalemen