Balloon pulmonary angioplasty in Takayasu arteritis with pulmonary artery involvement: a comparative study between patients with and without pulmonary hypertension

Takayasu arteritis (TA) is a rare large-vessel vasculitis, and pulmonary artery involvement (PAI) can cause severe stenosis and pulmonary hypertension (PH), markedly impairing exercise capacity and quality of life. Although balloon pulmonary angioplasty (BPA) has emerged as a promising interventional option, its preliminary efficacy and safety in TA-PAI—particularly in patients without PH—remain insufficiently defined. Therefore, this study aimed to evaluate the preliminary safety and differential clinical outcomes of BPA in patients with TA-PAI, stratified by the presence or absence of baseline PH. We retrospectively analyzed TA-PAI patients undergoing BPA. Hemodynamics, N-terminal pro-B-type natriuretic peptide (NT-proBNP), exercise capacity, and Quality of Life (QoL) were assessed pre- and post-BPA. Lesion anatomy and procedural complications were recorded. Statistical analyses compared PH and without PH subgroups. Among 33 TA-PAI patients, including 22 with PH and 11 without PH, BPA significantly reduced mPAP (25.41 ± 8.86 to 22.82 ± 7.94 mmHg, P = 0.005) and Pulmonary Vascular Resistance (PVR) from ( 3.06 [1.37,6.04] to 2.17 [1.35, 4.28] WU, P =0.039) in the overall population. In the PH subgroup, significant hemodynamic and functional improvements were observed, including reduced NT-proBNP ( P =0.024), increased 6-minute walk distance (6MWD) ( P =0.012), and enhanced QoL (all P <0.001). Conversely, the without PH group showed no significant hemodynamic changes ( P > 0.05) but demonstrated modest 6MWD increases and significant QoL improvements. Left pulmonary artery lesions were more prevalent in the PH group (42.0% vs. 5.7%, P < 0.001). The procedure was generally safe, with infrequent complications, including vascular dissection (1.6%) and haemoptysis (0.8%), occurring only in a small number of patients. BPA demonstrated acceptable safety and preliminary efficacy for symptomatic TA-PAI. Findings suggest preliminary functional and hemodynamic benefits in patients with baseline PH, whereas benefits in patients without PH were primarily limited to quality of life rather than hemodynamics. Larger controlled studies are needed to confirm these findings.