in CTEPH, and how might emerging data address these needs? - - PowerPoint PPT Presentation

Professor Marc Humbert

Professor of Respiratory Medicine, Université Paris-Saclay, Le Kremlin- Bicêtre, France

What is currently the greatest unmet clinical need in CTEPH, and how might emerging data address these needs?

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Cumulative incidence of CTEPH after a first episode of pulmonary embolism in patients without prior DVT

CTEPH, chronic thromboembolic pulmonary hypertension; DVT, deep vein thrombosis. Pengo V, et al. N Engl J Med 2004;350:2257–2264.

0.00 0.01 0.02 0.03 0.04 1 2 3 4 5 6 7 8 9 10 11

Cumulative incidence of CTEPH Years

Microvascular disease in CTEPH: Bronchial-to-pulmonary venous shunting

CTEPH, chronic thromboembolic pulmonary hypertension. Dorfmuller P, et al. Eur Respir J 2014;44:1275–1288.

Pulmonary artery Thromboembolic material Hypertrophic vasa vasorum Pulmonary vein Hypertrophic bronchial artery Bronchus Hemangiomatosis-like capillary remodeling Pulmonary vein remodeling

CTEPH treatment algorithm: A multimodal, individualized approach

a. Multidisciplinary: pulmonary endarterectomy surgeon, PH expert, BPA interventionist and radiologist. b. Treatment assessment may differ depending on the level of expertise. c. BPA without medical therapy can be considered in selected cases. BPA, balloon angioplasty; CTEPH, chronic thromboembolic pulmonary hypertension; PH, pulmonary hypertension. Kim NH, et al. Eur Respir J 2019;53:1801915.

CTEPH diagnosis Continue lifelong anticoagulation Treatment assessment by expert CTEPH teama,b Persistent/recurrent symptomatic pulmonary hypertension Operable Non-operable Pulmonary endarterectomy (treatment of choice) Targeted medical therapy with or without BPAb,c