Comprehensive Review of Diagnostic and Therapeutic Approaches for Chronic Thromboembolic Pulmonary Hypertension

Monday, March 31, 2025

4:50 PM – 4:55 PM CT

Location: Music City Center, 202 BC

Abstract Presenter(s)

Ashley Lamba

Medical Student
Zucker School of Medicine at Hofstra/Northwell, United States

Author/Co-author(s)

Eleanor C. Lee, MPH (she/her/hers)

Medical Student
University of Tennessee Health Science Center College of Medicine, United States
Satya K. Morar, MS (he/him/his)

Medical Student
Case Western Reserve University School of Medicine, United States
Abinaya Ramakrishnan

Medical Student
UCLA David Geffen School of Medicine, United States
JG

John Gossen, MD

VIR Resident
KP VISLA, United States
GV

Geogy Vatakencherry, MD, FSIR

Program Director of Vascular and Interventional Integrated Residency
Kaiser Permanente physician, United States

Learning Objectives:

Provide an overview of the pathogenesis and diagnostic workup of chronic thromboembolic pulmonary hypertension (CTEPH).

Review the various CTEPH management options.

Compare the clinical outcomes and adverse effects of medical vs. interventional therapies.

Background: Chronic thromboembolic pulmonary hypertension (CTEPH) is a severe form of pulmonary hypertension (PH) resulting from unresolved or recurrent pulmonary emboli (PE){1}. It is commonly linked to thrombophilic disorders and is characterized by an imbalance between clot formation and resolution{2}. Diagnosis typically involves ventilation-perfusion (V/Q) scans to identify mismatched perfusion defects, alongside CT pulmonary angiography to detect signs of PH and PE{2,3}. Pulmonary endarterectomy (PEA) is the definitive treatment for CTEPH, offering potential curative outcomes. However, balloon pulmonary angioplasty (BPA) is a valuable minimally invasive alternative for patients ineligible for surgery or with persistent PH post-PEA. Medical management with pulmonary vasodilators, anticoagulants, and diuretics can offer symptom relief, particularly in non-surgical candidates.

Clinical Findings/Procedure Details:
This exhibit will: (1) review the clinical presentation and diagnostic workup of CTEPH, (2) outline current medical, surgical, and interventional management options, highlighting key clinical trials (RACE, MR BPA, CHEST-2, etc.){4,5,6}, (3) discuss the technical considerations and outcomes of endovascular interventions, including balloon pulmonary angioplasty, (4) evaluate the current literature on treatment indications, outcomes, and adverse effects, and (5) integrate the literature and clinical guidelines into an evidence-based algorithm on the management of CTEPH. Case studies will be included to illustrate real-world applications of these therapies.

Conclusion and/or Teaching Points: This exhibit offers a comprehensive overview of CTEPH, emphasizing diagnostic workup and available treatment options. It provides insights into clinical efficacy, technical considerations, and the outcomes of both medical and interventional therapies, guiding evidence-based decision-making for CTEPH management.