Lung Injury After Balloon Pulmonary Angioplasty for CTEPH: Histopathologic Findings and Management Implications

31 August 2026

Zachary L. Steinberg, Tara Krishnan, Lia M. Barros, Jonathan Buber, Kelly D. Smith, Michael S. Mulligan, Peter J. Leary, Samuel G. Rayner

https://doi.org/10.1002/pul2.70390

 

Abstract

Balloon pulmonary angioplasty (BPA) has emerged as a guideline-recommended therapy for surgically inoperable chronic thromboembolic pulmonary hypertension (CTEPH). Lung injury occurs in approximately 6% of BPA sessions and is the leading cause of procedure-related mortality. While lung injury post-BPA has recently been associated with vascular injury and hemorrhage, pathologic evidence is lacking regarding whether injury is uniformly hemorrhagic or whether a permeability-mediated pattern, such as seen in reperfusion edema, predominates in some cases. We present a case of severe BPA-associated lung injury resulting in mortality, report the first histopathologic characterization of the parenchymal injury pattern in this setting, and describe how these findings informed successful rescue veno-arterial extracorporeal membrane oxygenation (VA-ECMO) in a second case.

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