Treatment of Symptomatic Chronic Thrombo-Embolic Pulmonary Disease with Mismatched Perfusion Defects and Fibrotic Clots, Without Pulmonary Hypertension

This protocol addresses a defined subset of patients with chronic thrombo-embolic pulmonary disease (CTEPD) who remain symptomatic despite anticoagulation, show mismatched perfusion defects on V/Q scan, and have evidence of chronic, organized, fibrotic clots on imaging — but do not meet criteria for pulmonary hypertension.

Clinical Scenario

Chronic thrombo-embolic pulmonary disease describes symptomatic patients with mismatched perfusion defects on V/Q scan and with signs of chronic, organized, fibrotic clots on CTPA or DSA, such as ring-like stenoses, webs/slits, and chronic total occlusions (pouch lesions or tapered lesions), after at least 3 months of therapeutic anticoagulation. This protocol applies specifically when pulmonary hypertension is absent.

Treatment Approach (partial overview)

For selected symptomatic patients, an interventional approach targeting the obstructed pulmonary vasculature is considered — with the specific procedure choice guided by the anatomical distribution and character of the lesions.

Full eligibility criteria, procedural selection algorithm, and evidence summary are in the structured protocol →

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1093/eurheartj/ehac237

Chronic thrombo-embolic pulmonary disease describes symptomatic patients with mismatched perfusion defects on V/Q scan and with signs of chronic, organized, fibrotic clots on CTPA or DSA, such as ring-like stenoses, webs/slits, and chronic total occlusions (pouch lesions or tapered lesions), after at least 3 months of therapeutic anticoagulation.
PEA or BPA should be considered in selected symptomatic patients with CTEPD without PH.
Selected symptomatic patients with CTEPD without PH can be successfully treated by PEA, with clinical and haemodynamic improvements at rest and exercise.
Selected symptomatic patients with CTEPD without PH and segmental/subsegmental lesions can successfully be treated by BPA, with clinical and haemodynamic improvements at rest and exercise.

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