Treatment offers new option to patients with blood clots in their lungs

CHICAGO — A new treatment used to clear clots from the lungs is providing a breath of fresh air for many patients.

After handling the "very demanding" work of a pipefitter for years, Mike Barr says he found himself struggling to climb even a few steps last year.

“It got extremely bad where I could climb maybe five steps and I would be out of breath gasping for air. When you get that way you start wondering, ‘Is this it?’” Barr said.

Barr’s health problems started in his lungs, where chronic clots blocked blood flow. The result was an enlarged right ventricle as his heart tried to pump even harder.

“The right heart is severely failing. It’s very dilated and hypertrophied,” explained Dr. Daniel Schimmel, an interventional cardiologist at Northwestern Medicine.

Mike first had surgery to remove the clots that blocked nearly all the circulation in his right lung. But there were more in the outer branches of both of his lungs that were too difficult to reach in surgery. That’s when Dr. Daniel Schimmel offered him balloon pulmonary angioplasty (BPA). In a manner similar to how angioplasties work in the heart, a balloon is inflated to help clear blockages and restore blood flow.

"The clot is not being removed. It’s being shoved to the side to open up space for blood flow,” Dr. Schimmel said.

The procedure was developed decades ago, but early versions failed when doctors inflated the blocked vessels too quickly, resulting in life-threatening bleeding and inflammation. Dr. Schimmel learned a modified, safer approach in Japan. He navigates a catheter from the groin to the pulmonary artery, and from there he can move into the smaller vessels, where he uses contrast dye to detect blockages. Then he inflates a balloon, stretching the vessel open.

“There’s data that looks at patients now three to five years after these procedures and show that we get a durable result where their pulmonary pressures stay low and their survival is better,” Dr. Schimmel said.

Patients are kept comfortable but are alert during the procedure. Unlike in the heart, stents aren’t used in the lungs because there’s too much movement. The BPA procedure is done in stages, so patients often have multiple procedures. First with small balloons, and then larger ones to stretch the vessel and restore blood flow.

“I could literally see when he put the probe into my lungs he would squirt dye, and I would see it only go a little bit. Then all of a sudden, he hit a spot where it cleared it, and all the dye went throughout my whole right lung,” Barr said.

Supplemental to traditional surgery, BPA is especially beneficial to those like Barr who have disease in the far corners of their lungs. Patients can visit Northwestern Medicine's website for more information.