Inhaled nitric oxide (NO) during balloon pulmonary angioplasty (BPA) was associated with fewer severe procedural complications in patients with chronic thromboembolic pulmonary disease (CTEPD), according to a retrospective analysis presented at ACC.26. The analysis found no adverse events directly linked to inhaled NO and no increase in overall complication rates during BPA.

The study evaluated 130 patients who underwent 635 BPA sessions involving 3,321 lesions between April 2016 and September 2025. Routine NO inhalation was introduced in December 2019. Sessions were categorized into a non-NO group comprising 59 patients undergoing 266 sessions and a NO group comprising 71 patients undergoing 369 sessions.

The primary safety endpoint was adverse events attributable to inhaled NO. Secondary endpoints included hemoptysis, use of positive-pressure ventilation (PPV) or nasal high-flow oxygen therapy, death, and composite severe complications defined as PPV/nasal high-flow oxygen therapy or death.

No NO-related adverse events were reported. Rates of any complication did not differ significantly between the non-NO and NO groups (11.7% vs 15.2%; p=0.20). Hemoptysis rates were also similar between groups (10.9% vs 15.2%; p=0.12), although the analysis used a broad definition that included minimal blood-streaked sputum. Severe complications occurred less frequently in the NO group compared with the non-NO group (0.3% vs 2.6%; p=0.009).

No adverse events directly attributed to inhaled NO were observed, and rates of overall complications and hemoptysis did not differ significantly between groups. These findings support NO inhalation as a viable option for intra-procedural pulmonary pressure control in patients with CTEPD.