Current Perspectives on Balloon Pulmonary Angioplasty for Chronic Thromboembolic Pulmonary Hypertension

Balloon pulmonary angioplasty (BPA) has become an established treatment modality for patients with inoperable chronic thromboembolic pulmonary hypertension (CTEPH), particularly in those with distal pulmonary artery lesions or significant comorbidities precluding pulmonary endarterectomy. BPA provides significant improvement in pulmonary hemodynamics, right ventricular function, exercise tolerance, and quality of life. Recent randomized controlled trials, including the RACE and MR-BPA trials, have demonstrated that BPA results in greater reduction in pulmonary vascular resistance and mean pulmonary arterial pressure compared to riociguat, although with a higher incidence of procedure-related complications. Ancillary follow-up data further suggest that a sequential strategy combining medical therapy and BPA may optimize outcomes and reduce adverse events. Advances in procedural techniques, imaging guidance, and patient selection have substantially improved the safety profile of BPA. International registries and expert consensus guidelines now support its incorporation into the multimodal management of CTEPH. This review synthesizes current evidence on the efficacy, safety, and practical aspects of BPA, while highlighting ongoing challenges, including long-term outcome data, standardization of treatment endpoints, and the role of combination therapy. BPA is poised to play an increasingly central role in personalized care strategies for CTEPH.