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

What is currently the greatest unmet clinical need in CTEPH, and how might emerging data address these needs? Professor Marc Humbert Professor of Respiratory Medicine, Université Paris-Saclay, Le Kremlin- Bicêtre, France

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Cumulative incidence of CTEPH after a first episode of pulmonary embolism in patients without prior DVT 0.04 Cumulative incidence of CTEPH 0.03 0.02 0.01 0.00 0 1 2 3 4 5 6 7 8 9 10 11 Years CTEPH, chronic thromboembolic pulmonary hypertension; DVT, deep vein thrombosis. Pengo V, et al. N Engl J Med 2004; 350 :2257 – 2264.

Microvascular disease in CTEPH: Bronchial-to-pulmonary venous shunting Bronchus Hypertrophic Pulmonary artery bronchial artery Thromboembolic material Pulmonary vein Hypertrophic vasa vasorum Hemangiomatosis-like capillary remodeling Pulmonary vein remodeling CTEPH, chronic thromboembolic pulmonary hypertension. Dorfmuller P, et al. Eur Respir J 2014; 44 :1275 – 1288.

CTEPH treatment algorithm: A multimodal, individualized approach Pulmonary endarterectomy (treatment of choice) Operable Treatment Persistent/recurrent CTEPH diagnosis assessment by symptomatic Continue lifelong expert CTEPH pulmonary anticoagulation team a,b hypertension Non-operable Targeted medical therapy with or without BPA b,c 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.