European Radiology

, Volume 29, Issue 3, pp 1276–1284 | Cite as

C-Arm computed tomography (CACT)-guided balloon pulmonary angioplasty (BPA): Evaluation of patient safety and peri- and post-procedural complications

  • Sabine K. Maschke
  • Jan B. HinrichsEmail author
  • Julius Renne
  • Thomas Werncke
  • Hinrich M. B. Winther
  • Kristina I. Ringe
  • Karen M. Olsson
  • Marius M. Hoeper
  • Frank K. Wacker
  • Bernhard C. Meyer



To assess the frequency and severity of complications of balloon pulmonary angioplasty (BPA) using C-arm computed tomography (CACT) guidance.

Material and methods

266 consecutive interventions in 67 patients (42 females, mean age 66 ± 13 years) were included. Selective CACT was acquired prior to the intervention for three-dimensional (3D) guidance and to select appropriate balloon size based on the measured vessel diameter. Complications during and after the procedure, the need for further interventions and the impact on patient safety and outcome were assessed and categorised according to the SIR Classification System to Complications by Outcome (Grade A–F).


Overall, 237 interventions were conducted without any complications (89.1%). Minor complications not requiring additional treatment occurred during or after 25 procedures (9.4%), including recurring dry cough in four patients during a total of 11 interventions (4.1%) (Grade A), three focal dissections of the targeted pulmonary artery (1.1%), four cases of pulmonary haemorrhage (1.5%), one case of reperfusion oedema (0.4%) and six cases of post-interventional short-term hemoptysis (2.3%) (Grade B). Four cases of major complications requiring additional treatment were observed (1.5%): one case of pulmonary haemorrhage (0.4%) and two cases of post-interventional haemoptysis (0.8%), all resolved after medical therapy without requiring further intervention, and one case of atrial tachycardia induced during catheterisation, subsequently requiring pharmacological cardioversion (0.4%) (Grade C). No fatal or life-threatening peri- or post-interventional complications or mortality were observed (Grade D–F).


BPA performed under CACT guidance appears to be a safe procedure with a low risk of severe complications.

Key Points

• CACT guidance of BPA is safe and successful.

• CACT-guided BPA procedures have a low complication profile.

• CACT guidance is a valuable tool to navigate BPA.


Pulmonary hypertension Cone beam computed tomography Angioplasty 





Balloon pulmonary angioplasty


C-arm computed tomography


Chronic thromboembolic pulmonary hypertension


Digital subtraction angiography


Intravascular ultrasound


Low molecular-weight heparin


Multidetector computed tomography


Mean pulmonary artery pressure


Optical coherence tomography


Pulmonary endarterectomy


Pulmonary vascular resistance


Ventilation/perfusion single photon emission computed tomography



The study was funded in parts by personal grants from the “Junge Akademie” of Hannover Medical School (Dr. Maschke, Dr. Hinrichs and Dr. Renne).

Compliance with ethical standards


The scientific guarantor of this publication is Frank Wacker.

Conflict of interest

The authors of this manuscript declare relationships with the following companies: Siemens Healthcare and ProMedicus (Bernhard Meyer and Frank Wacker; outside the submitted work); Bayer (Marius Hoeper and Karen Olsson; outside the submitted work). The remaining authors declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors has significant statistical expertise.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.


• Retrospective

• Experimental/intra-individual comparison

• Performed at one institution


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Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  • Sabine K. Maschke
    • 1
  • Jan B. Hinrichs
    • 1
    Email author
  • Julius Renne
    • 1
  • Thomas Werncke
    • 1
  • Hinrich M. B. Winther
    • 1
  • Kristina I. Ringe
    • 1
  • Karen M. Olsson
    • 2
  • Marius M. Hoeper
    • 2
  • Frank K. Wacker
    • 1
  • Bernhard C. Meyer
    • 1
  1. 1.Department of Diagnostic and Interventional Radiology, Member of the German Center for Lung Research (DZL)Hannover Medical SchoolHannoverGermany
  2. 2.Clinic for Pneumology, Member of the German Center for Lung Research (DZL)Hannover Medical SchoolHannoverGermany

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