DOI: 10.1177/17534666261492547 ISSN: 1753-4666

Balloon pulmonary angioplasty for occlusive lesions of pulmonary artery in Takayasu arteritis: A cohort study

Xin Li, Tao Yang, Qin Luo, Qing Zhao, Zhihua Huang, Anqi Duan, Yijia Wang, Luyang Gao, Sicong Li, Qi Wang, Jingjing Xiang, Huiyi Liu, Changming Xiong, Zhihui Zhao, Zhihong Liu
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Background

Occlusive pulmonary arterial lesions represent a major technical challenge for balloon pulmonary angioplasty (BPA) in patients with Takayasu arteritis–associated pulmonary artery involvement. However, evidence and procedural guidance regarding BPA for occlusive lesions in this population remain limited.

Objectives

This study aimed to summarize our center experience with BPA for occlusive pulmonary arterial lesions in patients with Takayasu arteritis and to identify potential risk factors associated with restenosis after BPA.

Design

Retrospective cohort.

Methods

We retrospectively enrolled patients with Takayasu arteritis who had occlusive pulmonary arterial lesions. Lesions were morphologically categorized as subtotal or total occlusions. Total occlusions were further subclassified as cone-shaped, pouch-like, or ostial occlusions.

Results

We included 66 patients with Takayasu arteritis, in whom 182 occlusive lesions were identified. In terms of locations, most ostial occlusions (56.52%) located lobar, while other kinds of lesions more common located segmentally. Total occlusions more frequently required guide-extension catheter support than subtotal occlusions (70.21% vs. 40.63%, P <0.001). Hard-tip guidewires were required for revascularization in 53.85% of ostial occlusions, compared with only 3.13% of subtotal occlusions. Lesion-level technical success rates among attempted lesions decreased with increasing lesion complexity: 100% for subtotal occlusions, 96.0% for cone-shaped occlusions, 68.4% for pouch-like occlusions, and 43.8% for ostial occlusions. The corresponding recanalization rates among all identified lesions were 78.69%, 88.9%, 52.04%, and 10.14%, respectively. In exploratory univariable Firth penalized logistic regression, irregular anticoagulation was associated with a higher likelihood of restenosis (OR 8.51, 95% CI 1.39–60.91; P=0.021), whereas baseline hemodynamics were not associated with restenosis.

Conclusion

The techniques and devices illustrated in this study might guide the BPA performance in addressing occlusive lesions.

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