rpcardioRational Pharmacotherapy in CardiologyРациональная Фармакотерапия в Кардиологии1819-64462225-3653«SILICEA-POLIGRAF» LLC10.20996/1819-6446-2021-04-02rpcardio-2438Research ArticlePOINT OF VIEWТОЧКА ЗРЕНИЯTreatment Strategy Options in Inoperable Chronic Thromboembolic Pulmonary Hypertension PatientsПринципы выбора лечебной стратегии у пациентов с неоперабельной формой хронической тромбоэмболической легочной гипертензииhttps://orcid.org/0000-0003-0736-6278МарукянН. В.MarukyanN. V.

Марукян Нарек Вачаганович

Санкт-Петербург

Narek V. Marukyan

Saint-Petersburg

https://orcid.org/0000-0001-9478-1941СимаковаМ. А.SimakovaM. A.

Симакова Мария Александровна - eLibrary SPIN 3841-6593

Санкт-Петербург

Maria A. Simakova - eLibrary SPIN 3841-6593

Saint-Petersburg

maria.simakova@gmail.comhttps://orcid.org/0000-0002-2726-7632ЗубаревД. Д.ZubarevD. D.

Зубарев Дмитрий Дмитриевич

Санкт-Петербург

Dmitri D. Zubarev

Saint-Petersburg

https://orcid.org/0000-0002-7817-3847МоисееваО. М.MoiseevaO. M.

Моисеева Ольга Михайловна – eLibrary SPIN 1492-3900

Санкт-Петербург

Olga M. Moiseeva - eLibrary SPIN 1492-3900

Saint-Petersburg

Национальный медицинский исследовательский центр имени В.А. АлмазоваРоссияAlmazov National Medical Research CentreRussian Federation202106052021172278285Copyright © Marukyan N.V., Simakova M.A., Zubarev D.D., Moiseeva O.M., 20212021Марукян Н.В., Симакова М.А., Зубарев Д.Д., Моисеева О.М.Marukyan N.V., Simakova M.A., Zubarev D.D., Moiseeva O.M.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.rpcardio.online/jour/article/view/2438

This review presents an analysis of recent publications on the principles of diagnosis and management of patients with chronic thromboembolic pulmonary hypertension (CTEPH). The authors emphasize the importance of patient's operability assessment regarding the possibility of performing pulmonary thrombendarterectomy - a radical treatment option due to complete post-thrombotic material removal from the branches of the pulmonary artery. In the case of an inoperable type of CTEPH, such a method of transcatheter treatment as step-by-step balloon angioplasty of the pulmonary artery (BPA) is proposed. The article clearly outlines the principles of selection, patient training and techniques for BPA. The authors demonstrated their own patented method of the peripheral vascular bed visualization in the case of recanalization of chronic occlusions, which increases the safety of this intervention. Particular attention is paid to hybrid approaches using a soluble guanylate cyclase stimulator, riociguate in combination with BPA for high risk CTEPH patients. The review presents the data of the post hoc analysis of the CHEST-1 study and the data of real clinical practice of the use of riociguat in combination with the endovascular method of treatment on the example of the leading expert groups in Europe, who demonstrated in their studies the positive effect of riociguat on the hemodynamic parameters and the frequency of perioperative complications.

В настоящем обзоре представлен анализ последних публикаций, посвященных принципам диагностики и ведения пациентов с хронической тромбоэмболической легочной гипертензией (ХТЭЛГ). Подчеркивается важность оценки «операбельности»» больного в экспертном центре в отношении возможности выполнения легочной тромбэндартерэктомии - радикального варианта лечения с удалением посттромботического материала из ветвей легочной артерии. В случае неоперабельного типа ХТЭЛГ предлагается такой метод транскатетерного лечения, как поэтапная баллонная ангиопластика легочной артерии (БАП ЛА). В статье четко прописаны принципы отбора, подготовки пациентов и техники выполнения БАП ЛА. Продемонстрирован запатентованный авторами метод визуализации периферического сосудистого русла в случае реканализации хронических окклюзий, применение которого повышает безопасность этого вмешательства. Особое внимание в статье уделяется гибридным подходам с использованием стимулятора растворимой гуанилатциклазы, препарата риоцигуата в сочетании с БАП ЛА у пациентов с ХТЭЛГ высокого риска. В обзоре представлены данные post hoc анализа исследования CHEST-1 и данные реальной клинической практики применения риоцигуата в сочетании с эндоваскулярным методом лечения на примере ведущих экспертных групп Европы, продемонстрировавших в своих исследованиях положительное влияние риоцигуата на показатели гемодинамики малого круга кровообращения и частоту периоперационных осложнений.

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The authors declare that there are no conflicts of interest present.