Balloon Pulmonary Angioplasty for Chronic Thromboembolic Pulmonary Hypertension: Patient Selection, Procedural Pearls, and Expected Outcomes

Chronic thromboembolic pulmonary hypertension (CTEPH) is a progressive condition characterized by persistent thromboembolic disease in the pulmonary arteries, leading to increased pulmonary vascular resistance and right heart failure. Medical therapy offers symptomatic relief but is not curative. Pulmonary thromboendarterectomy (PTE) remains the gold standard treatment; however, patients are often ineligible for surgery due to unfavorable anatomy, comorbidities, or preferences. Balloon pulmonary angioplasty (BPA) has emerged as a minimally invasive alternative, particularly for patients with inoperable CTEPH or post-PTE patients who remain symptomatic. Balloon catheters are used to dilate stenotic pulmonary arteries and to disrupt intraluminal webs and synechia, improving hemodynamics and leading to better quality of life. Careful patient selection for BPA is crucial, requiring a multidisciplinary approach to identify suitable candidates. Although BPA has demonstrated favorable outcomes, challenges remain in optimizing procedural techniques, reducing complication rates, and establishing standardized treatment protocols. This work aims to review BPA and its role in treating CTEPH, from patient selection to expected outcomes, as well as potential areas of future research, which includes the need for increased awareness and accessibility to specialized CTEPH centers, advancements in imaging technology, procedural standardization, and investigation of combination therapies to further support BPA efficacy and improve patient outcomes.