Acute outcomes for the full US cohort of the FLASH mechanical thrombectomy registry in pulmonary embolism&amp;nbsp;

Toma, Catalin; Weinberg, Mitchell D.; Bunte, Matthew C.; Khandhar, Sameer; Stegman, Brian; Gondi, Sreedevi; Chambers, Jeffrey W.; Amin, Rohit; Leung, Daniel A.; Kado, Herman; Brown, Michael A.; Sarosi, Michael G.; Bhat, Ambarish P.; Castle, Jordan; Savin, Michael A.; Siskin, Gary P.; Rosenberg, Michael S.; Fanola, Christina; Horowitz, James; Pollak, Jeffrey

doi:10.4244/eij-d-22-00732

Cited by 81 publications

(59 citation statements)

References 26 publications

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“…The findings of the PEITHO study does not support routine thrombolysis for non-massive PE due to the excess bleeding risk of systemic thrombolysis with 100 mg alteplase without any significant reduction in PE related mortality. Furthermore, as many as 32% of PE patients have contraindications to thrombolysis, 13% may fail to respond to thrombolysis and residual pulmonary obstruction with or without thrombolysis is an adverse prognostic marker for in-hospital and long-term survival [ 14 , 15 ]. We had previously reported a similar survival to discharge rate of 70% and 89.2% for high-risk and intermediate-risk PE out of 321 acute PE patients from our institution [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

First use of large-bore suction thrombectomy for acute pulmonary embolism in Asia-Pacific: feasibility and short-term clinical outcomes

Kojodjojo

Ong

Loh

et al. 2023

J Thromb Thrombolysis

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Clinical outcomes for intermediate or high-risk pulmonary emboli (PE) remain sub-optimal, with limited improvements in survival for the past 15 years. Anticoagulation alone results in slow thrombus resolution, persistent right ventricular (RV) dysfunction, patients remaining at risk of haemodynamic decompensation and increased likelihood of incomplete recovery. Thrombolysis elevates risk of major bleeding and is thus reserved for high-risk PE. Thus, a huge clinical need exists for an effective technique to restore pulmonary perfusion with minimal risk and avoidance of lytic therapy. In 2021, large bore suction thrombectomy (ST) was introduced in Asia for the first time and this study assessed the feasibility and short-term outcomes of Asian patients undergoing ST for acute PE. 40 consecutive patients (58% male, mean age of 58.3 ± 16.6 years) with intermediate (87.5%) or high-risk PE (12.5%) were enrolled in this prospective registry. 20% had prior VTE, 42.5% had contraindications to thrombolysis, and 10% failed to respond to thrombolysis. PE was idiopathic in 40%, associated with active cancer in 15% and post-operative status in 12.5%. Procedural time was 124 ± 30 min. Emboli were aspirated in all patients without the need for thrombolytics, resulting in a 21.4% reduction in mean pulmonary arterial pressures and 123% increase TASPE-PASP ratio, a prognostic measure of RV-arterial coupling. (both p < 0.001) Procedural complications were 5% and 87.5% patients survived to discharge without symptomatic VTE recurrence during 184 days of mean follow-up. ST affords an effective reperfusion option for PE without thrombolytics, normalises RV overload and provides excellent short-term clinical outcomes. Key points• Large bore suction thrombectomy is an effective minimally invasive reperfusion therapy for patients with intermediate or high-risk pulmonary embolism (PE), without the use of thrombolytics. • Significant reductions in mean pulmonary arterial pressures and heart rates were achieved, resulting in normalisation of right ventricular (RV) strain, size and improvement in RV-pulmonary arterial coupling and stroke volumes. • 95% of PE patients who did not require cardiopulmonary resuscitation, survived to discharge without VTE recurrence during 184 days of mean follow-up. • Ongoing multi-centre randomized controlled trials comparing suction thrombectomy to routine care will confirm the benefits of early catheter-based reperfusion therapy for PE.

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Section: Discussionmentioning

confidence: 99%

First use of large-bore suction thrombectomy for acute pulmonary embolism in Asia-Pacific: feasibility and short-term clinical outcomes

Kojodjojo

Ong

Loh

et al. 2023

J Thromb Thrombolysis

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“…The ongoing, multicentre, prospective FLASH registry is designed to investigate the safety and effectiveness of the second-generation FlowTriever device 132 , 133 . The results from the first 800 patients included in the USA have been reported.…”

Section: Interventional Therapiesmentioning

confidence: 99%

“…The results from the first 800 patients included in the USA have been reported. Of these, approximately 8% had high-risk PE and 92% had intermediate-risk PE (of which 83% were intermediate–high-risk PE) 133 . Approximately one-third of the included patients had thrombolytic contraindications, representing a common PE cohort.…”

Section: Interventional Therapiesmentioning

confidence: 99%

“…At baseline, patients presented with a mean composite RV-to-LV ratio of 1.50 ± 0.46 (as assessed by CTPA) and a mean sPESI score of 1.6 ± 1.1, and 13% of patients presented with severe pulmonary hypertension with a systolic PAP of >70 mmHg (ref. 133 ). The total median procedure time was 66 min (IQR 51–92 min) and median blood loss due to aspiration was 225.0 ml (IQR 95–400 ml) 133 .…”

Section: Interventional Therapiesmentioning

confidence: 99%

“… 133 ). The total median procedure time was 66 min (IQR 51–92 min) and median blood loss due to aspiration was 225.0 ml (IQR 95–400 ml) 133 . A total of 734 patients completed the 30-day follow-up.…”

Section: Interventional Therapiesmentioning

confidence: 99%

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Interventional therapies for pulmonary embolism

et al. 2023

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Pulmonary embolism (PE) is the leading cause of in-hospital death and the third most frequent cause of cardiovascular death. The clinical presentation of PE is variable, and choosing the appropriate treatment for individual patients can be challenging. Traditionally, treatment of PE has involved a choice of anticoagulation, thrombolysis or surgery; however, a range of percutaneous interventional technologies have been developed that are under investigation in patients with intermediate–high-risk or high-risk PE. These interventional technologies include catheter-directed thrombolysis (with or without ultrasound assistance), aspiration thrombectomy and combinations of the aforementioned principles. These interventional treatment options might lead to a more rapid improvement in right ventricular function and pulmonary and/or systemic haemodynamics in particular patients. However, evidence from randomized controlled trials on the safety and efficacy of these interventions compared with conservative therapies is lacking. In this Review, we discuss the underlying pathophysiology of PE, provide assistance with decision-making on patient selection and critically appraise the available clinical evidence on interventional, catheter-based approaches for PE treatment. Finally, we discuss future perspectives and unmet needs.

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Ultrasound‐assisted endovascular thrombolysis versus large‐bore thrombectomy in acute intermediate‐high risk pulmonary embolism: The propensity‐matched EKNARI cohort study

Al‐Terki,

Lauder,

Mügge

et al. 2024

Cathet Cardio Intervent

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BackgroundUltrasound‐assisted thrombolysis (USAT) and large‐bore‐thrombectomy (LBT) are under investigation for the treatment of intermediate‐high and high‐risk pulmonary embolisms (PE). Comparative studies investigating both devices are scarce.AimsThis study aimed to compare the safety and efficacy of the two most frequently used devices for treatment of acute PE.MethodsThis multicenter, retrospective study included 125 patients undergoing LBT or USAT for intermediate‐ or high‐risk PE between 2019 and 2023. Nearest neighbor propensity matching with logistic regression was used to achieve balance on potential confounders. The primary outcome was the change in the right to left ventricular (RV/LV) ratio between baseline and 24 h.ResultsA total of 125 patients were included. After propensity score matching, 95 patients remained in the sample, of which 69 (73%) underwent USAT and 26 (27%) LBT. The RV/LV ratio decrease between baseline and 24 h was greater in the LBT than in the USAT group (adjusted between‐group difference: −0.10, 95% CI: −0.16 to −0.04; p = 0.001). Both procedures were safe and adverse events occurred rarely (10% following USAT vs. 4% following LBT; p = 0.439).ConclusionIn acute intermediate‐high and high‐risk PE, both LBT and USAT were feasible and safe. The reduction in RV/LV ratio was greater following LBT than USAT. Further randomized controlled trials are needed to confirm these findings.

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Acute outcomes for the full US cohort of the FLASH mechanical thrombectomy registry in pulmonary embolism

Cited by 81 publications

References 26 publications

First use of large-bore suction thrombectomy for acute pulmonary embolism in Asia-Pacific: feasibility and short-term clinical outcomes

First use of large-bore suction thrombectomy for acute pulmonary embolism in Asia-Pacific: feasibility and short-term clinical outcomes

Interventional therapies for pulmonary embolism

Ultrasound‐assisted endovascular thrombolysis versus large‐bore thrombectomy in acute intermediate‐high risk pulmonary embolism: The propensity‐matched EKNARI cohort study

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