The following is a summary of “Angiographic classification of pulmonary vascular lesion in Takayasu arteritis: A cohort study,” published in the July 2023 issue of Pulmonology by Yang, et al.
Percutaneous transluminal pulmonary angioplasty (PTPA) has emerged as a promising intervention for improving hemodynamics and prognosis in Takayasu arteritis and pulmonary artery involvement patients. However, the selection of PTPA as a treatment option is largely based on clinical experience rather than a systematic classification of pulmonary artery lesions. For a study, researchers sought to address this gap by classifying pulmonary artery lesions in Takayasu arteritis using pulmonary angiogram findings and assessing the success rate and technical difficulty of PTPA for different lesion types.
The study enrolled a consecutive cohort of patients diagnosed with Takayasu arteritis and pulmonary artery involvement who had undergone pulmonary angiography.
Based on pulmonary angiography results, the analysis identified 365 pulmonary vascular lesions in 63 patients. These lesions were categorized into four groups (types A, B, C, and D) based on their morphology, distal blood flow, and PTPA treatment success rate. Further subclassification of total occlusion (type D) was done into D1 (cone-shape occlusion), D2 (pocket-like occlusion), and D3 (ostium occlusion). The success rate of PTPA was higher for stenosis and subtotal occlusion (types A and C), while ostium occlusion (type D3) had the lowest success rate. The two-year survival rate for patients who underwent PTPA was 97.3%.
The study highlighted the significance of pulmonary lesion morphology in Takayasu arteritis in determining the success of PTPA. The classification scheme provided valuable insights, indicating that stenosis and subtotal occlusion lesions are more amenable to PTPA, while ostium occlusion lesions pose more significant challenges. The findings may serve as a helpful guide for selecting and applying PTPA for pulmonary artery lesions in Takayasu arteritis.
Source: resmedjournal.com/article/S0954-6111(23)00225-1/fulltext