Percutaneous Transluminal Pulmonary Angioplasty for Takayasu Arteritis-Associated Pulmonary HTN

Percutaneous transluminal pulmonary angioplasty (PTPA) may be a promising therapeutic option for patients with Takayasu arteritis-associated pulmonary hypertension (TA-PH), according to results of a study published in the Journal of the American College of Cardiology.

Between 2016 and 2019, all patients with TA-PH at the Peking Union Medical College Hospital in China were prospectively enrolled in this cohort study. PTPA was recommended to all patients. Clinical outcomes were compared between patients who underwent PTPA (n=50) with those who refused the treatment (n=21).

The PTPA and non-PTPA groups were aged mean 40±14 and 40±16 years; 82.0% and 71.4% were women; 34.0% and 28.6% had carotid artery involvement; 28.0% and 33.3% had subclavian artery involvement; 32.0% and 52.4% had aortic involvement; and 16.0% and 28.6% had renal artery involvement, respectively.

During the 150 PTPA sessions, 478 lesions were observed and 75.3% were treated successfully. The lesions were stenosis (62.8%) or occlusions (37.2%) and located in the segmental branches (53.5%), subsegmental branches (32.0%), lobar branches (10.7%), and pulmonary trunk (3.8%).

During a mean follow-up of 37 months, mortality occurred among 6.0% of the PTPA recipients and 28.6% of the non-PTPA group. The 3-year survival rates were 93.7% among the PTPA cohort and 76.2% among the non-PTPA cohort (P =.0096).

PTPA decreased risk for all-cause mortality (hazard ratio [HR], 0.18; 95% CI, 0.05-0.73; P =.017).

Among the subset of patients without pulmonary artery involvement (n=323), the 3-year survival rate was 96.5%. Patients in the non-PTPA group had increased risk of all-cause mortality compared with patients in the nonpulmonary artery involvement group (HR, 7.71; 95% CI, 2.93-20.27; P <.001). The nonpulmonary artery cohort and the PTPA recipients were at similar risk for all-cause mortality (HR, 1.62; 95% CI, 0.45-5.83; P =.463).

PTPA was associated with greater changes to pulmonary vascular resistance (adjusted mean difference [aMD], -3.4; 95% CI, -5.1 to -1.7 WU; P <.001), 6-minute walking distance (aMD, 83; 95% CI, 45-119 m; P <.001), mean pulmonary arterial pressure (aMD, -12; 95% CI, -19 to -4 mmHg; P =.003), mixed venous oxygen saturation (aMD, 4.7%; 95% CI, 1.5%-8.1%; P =.007), and cardiac index (aMD, 0.4; 95% CI, 0.01-0.8 L/min/m²; P =.047).

During all PTPA sessions, 18.7% had a complication. There were 27 pulmonary artery injuries, 6 lung injuries, and 1 contrast-induced nephropathy.

This study was limited by its short follow-up time and did not evaluate late vessel restenosis or Takayasu arteritis relapse.

“PTPA tended to be associated with a reduced risk of all-cause mortality with acceptable safety profiles and seemed to be a promising therapeutic option for TA-PH patients,” the study authors wrote. “These findings need to be confirmed by randomized controlled trials.”