Balloon Pulmonary Angioplasty vs. Combined Approach With Pulmonary Artery Denervation in CTEPH: Effectiveness Comparison

Chronic Thromboembolic Pulmonary Hypertension Clinical Trial

— BPA-PADN  

Official title:

Comparing Effectiveness of Balloon Pulmonary Angioplasty Alone vs. Combined With Pulmonary Artery Denervation in Chronic Thromboembolic Pulmonary Hypertension Patients Receiving Standard Medical Therapy

Clinical Trial Details — Status: Enrolling by invitation

Administrative data

• NCT number: NCT06209710
• Other study ID #: 65/2023
• Status: Enrolling by invitation
• Phase: Phase 2/Phase 3
• Start date: April 1, 2024
• Est. completion date: December 2025

Study information

• Verified date: April 2024
• Source: Military Medical Academy, Belgrade, Serbia
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

This clinical trial investigates new treatment approaches for chronic thromboembolic pulmonary hypertension (CTEPH), a condition affecting the lungs' blood vessels. CTEPH often develops after repeated blood clots in the lungs, leading to increased pressure and strain on the heart. The study aims to assess the effectiveness of combining two treatments, balloon pulmonary angioplasty (BPA) and pulmonary artery denervation (PADN), in reducing blood pressure in the lungs compared to the standard treatment. Additionally, the trial will explore the impact of these treatments on patients' quality of life. The hope is to improve outcomes and provide valuable insights into managing this challenging condition.

Description:

This clinical trial focuses on advancing our understanding and treatment of chronic thromboembolic pulmonary hypertension (CTEPH). CTEPH arises when blood clots in the lungs fail to fully dissolve, leading to the formation of fibrous masses that obstruct blood vessels, increase pulmonary blood pressure, and strain the heart's right ventricle.

The study's primary objective is to evaluate the combined use of two innovative treatments, Balloon Pulmonary Angioplasty (BPA) and Pulmonary Artery Denervation (PADN), in comparison to the standard treatment for CTEPH. BPA involves using a balloon to open narrowed or blocked pulmonary arteries, while PADN is a novel therapy targeting nerve clusters near the main pulmonary artery to reduce blood pressure.

The trial also aims to assess the impact of these treatments on patients' quality of life and clinical improvement measured through the 6-Minute Walk Test Distance (6-MWTD) and the Cambridge Pulmonary Hypertension Outcome Review (CAMPHOR) questionnaires.In addition to evaluating the combined efficacy of BPA and PADN compared to standard treatment, this clinical trial has a specific objective to customize the PADN intervention based on individual patient characteristics. The study aims to determine the optimal number of radiofrequency (RF) ablation points required for effective PADN, considering the pulmonary artery size or diameter. This innovative approach seeks to tailor the intervention to the unique anatomical features of each patient, enhancing the precision and effectiveness of the treatment strategy.

The study design is a randomized parallel cohort study involving patients with CTEPH in phases 2/3. Patients are divided into two groups-intervention and control-and receive distinct treatment protocols. The intervention group undergoes a combination of BPA, PADN, and standard drug therapy, while the control group receives BPA, sham PADN intervention and standard drug therapy.

The BPA procedure involves accessing the pulmonary artery through the right femoral vein, measuring pressures, and selectively dilating stenosed or occluded branches. After the BPA procedure, PADN is performed by applying radiofrequency energy near the bifurcation of the main pulmonary artery.The sham PADN involves catheter placement mimicking the actual procedure without the application of radiofrequency energy.

The study includes detailed criteria for patient inclusion and exclusion, and patients are closely monitored through scheduled face-to-face visits. The trial plans to enroll approximately 20 patients.

Data management ensures the confidentiality of patient information, and analysis includes a descriptive approach and comparison of mPAP reduction after three months.

The study follows ethical guidelines, Good Clinical Practice, and recommendations from the European Association of Cardiology. Informed consent is a crucial aspect, and patient safety is paramount throughout the trial.

The trial's ultimate goal is to contribute valuable insights into the efficacy of combining BPA and PADN as a potential treatment strategy for CTEPH, aiming to improve patient outcomes and enhance our approach to managing this complex condition.

Recruitment information / eligibility

• Status: Enrolling by invitation
• Enrollment: 20
• Est. completion date: December 2025
• Est. primary completion date: August 2025
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years to 80 Years

Eligibility

Inclusion Criteria:

• Written informed consent.

• Age 18 - 80 years.

• Diagnosis of chronic thromboembolic heart disease.

• Mean pulmonary arterial pressure (mPAP) >20 mmHg.

• Pulmonary vascular resistance >3 Wood units.

• Presence of organized thrombus masses.

• World Health Organization (WHO) functional class II to IV.

Exclusion Criteria:

• Proximal organized thrombotic masses not suitable for Balloon Pulmonary Angioplasty (BPA) and Pulmonary Artery Denervation (PADN).

• WHO functional class I

Additionally, participants can be excluded from the trial under the following circumstances:

• Withdrawal of consent at any time.

• Failure to complete the treatment as per protocols.

• Protocol violations.

Related Conditions & MeSH terms

• Chronic Thromboembolic Pulmonary Hypertension
• Hypertension
• Hypertension, Pulmonary

Intervention

Procedure:
• Balloon Pulmonary Angioplasty combined with Pulmonary Artery Denervation
Participants in the intervention arm will undergo a combination of Balloon Pulmonary Angioplasty (BPA) and Pulmonary Artery Denervation (PADN), as part of this phase 2/3 clinical trial. The trial aims to determine the optimal number of radiofrequency (RF) ablation points required for effective PADN based on pulmonary artery size or diameter. The BPA procedure addresses segmental and subsegmental thrombi masses through pulmonary artery dilation, while the PADN procedure involves the placement of a denervation catheter near the bifurcation of the main pulmonary artery. RF energy is selectively applied, and ablation points are determined based on individual patient characteristics and expected therapeutic effects. This unique approach seeks to customize the intervention to the patient's specific pulmonary anatomy, contributing to the overall effectiveness of the treatment strategy.
• Balloon Pulmonary Angioplasty with Sham Pulmonary Artery Denervation
Participants receive Balloon Pulmonary Angioplasty (BPA) combined with a sham Pulmonary Artery Denervation (PADN) procedure. The sham PADN involves catheter placement mimicking the actual procedure without the application of radiofrequency energy

Locations

Country	Name	City	State
Serbia	Military Medical Academy	Belgrade

Sponsors (3)

Lead Sponsor	Collaborator
Boris Dzudovic	Galen Research, Military Medical Academy, Belgrade, Serbia

Country where clinical trial is conducted

Serbia, 

References & Publications (2)

Chen SL, Zhang FF, Xu J, Xie DJ, Zhou L, Nguyen T, Stone GW. Pulmonary artery denervation to treat pulmonary arterial hypertension: the single-center, prospective, first-in-man PADN-1 study (first-in-man pulmonary artery denervation for treatment of pulmonary artery hypertension). J Am Coll Cardiol. 2013 Sep 17;62(12):1092-1100. doi: 10.1016/j.jacc.2013.05.075. Epub 2013 Jul 10. — View Citation

Zhang H, Wei Y, Zhang C, Yang Z, Kan J, Gu H, Fan F, Gu H, Wang Q, Xie D, Zhang G, Guo X, Yin Y, Jin B, Zhou H, Yang Z, Wang Z, Xin Y, Zhang C, Meng L, Wang X, Sun J, Zhao C, Zhang J, Yan X, Chen F, Yao C, Stone GW, Chen SL. Pulmonary Artery Denervation for Pulmonary Arterial Hypertension: A Sham-Controlled Randomized PADN-CFDA Trial. JACC Cardiovasc Interv. 2022 Dec 12;15(23):2412-2423. doi: 10.1016/j.jcin.2022.09.013. Epub 2022 Sep 18. — View Citation

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Change in mean Pulmonary Arterial Pressure (mPAP)	Measure the change in mPAP from baseline to 3 months post-intervention to assess the effectiveness of the combined BPA and PADN therapy.	3 months
Secondary	Quality of Life Assessment	Measure: Cambridge Pulmonary Hypertension Outcome Review (CAMPHOR) Questionnaire.; Scale: Units on a scale.; Scale Details: CAMPHOR consists of three sections: Symptoms (Impairment) Scale (0-25): Higher scores indicate a greater extent of symptoms experienced by the patient.; Activities (Disability) Scale (0-30): Higher scores indicate more significant limitations in performing daily activities affected by chronic thromboembolic pulmonary hypertension.; Quality of Life Scale (0-25): Higher scores reflect a greater impact of the condition on various aspects of the patient's overall quality of life.	3 months, and 1 year
Secondary	Physical Functionality Assessment	Measure: 6-Minute Walk Test Distance (6-MWTD). Unit of Measure: Meters. Description: The 6-Minute Walk Test evaluates the physical functional capacity of patients with CTEPH. It measures the total distance covered by patients in a six-minute period, providing insight into their exercise tolerance and overall physical performance.	3 months, and 1 year
Secondary	Hemodynamic Response Assessment	Measure: Mean Pulmonary Arterial Pressure (mPAP) change. Unit of Measure: mmHg. Description: Assesses mPAP reduction after 1 year	1 year
Secondary	Adverse Events	Measure: Number of Participants with Documented and Categorized Adverse Events, Including Intensity and Type (e.g., cardiovascular events, bleeding events, procedural complications), to Evaluate Safety.	3 months, abd 1 year
Secondary	Survival Rates	Monitor one-year survival rate to provide insights into the long-term outcomes of the intervention	1 year