Chronic total occlusions (CTOs) in chronic thromboembolic pulmonary disease (CTEPD) present technical challenges during balloon pulmonary angioplasty (BPA), with historically lower procedural success rates. In a prospective registry published in Catheterization and Cardiovascular Interventions, outcomes of CTO-targeted BPA were evaluated, including technical success, procedural strategies, and hemodynamic changes, with comparison to non-CTO BPA interventions.

The analysis included 37 patients with 84 CTO lesions treated between August 2019 and July 2024. Outcomes assessed included per-lesion technical success, revascularization methods, follow-up patency, hemodynamic parameters, and procedural complications.

Revascularization was achieved in 94% of CTO lesions, with 80% success on the first attempt. Subintimal or extravascular wire entry was frequently managed using the Microcatheter Injection, Retraction, and Reentry (MIRaR) technique. Follow-up patency was 96%, and the overall per-procedure complication rate was 10%, with most events clinically insignificant.

Baseline hemodynamic parameters were worse in the CTO group compared with non-CTO interventions; however, no significant differences were observed after treatment. Total and clinically significant complication rates were similar between groups.

These findings indicate that CTO-targeted BPA can achieve high technical success with comparable safety and post-procedural hemodynamics to non-CTO interventions.