Acute pulmonary embolism: endovascular therapy

Reis, Stephen P.; Zhao, Ken; Ahmad, Noor Ani; Widemon, R.; Root, Christopher W.; Toomay, Seth; Horowitz, James; Sista, Akhilesh K.

doi:10.21037/cdt.2017.12.05

Cited by 14 publications

(16 citation statements)

References 45 publications

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“…An 8F catheter was used for thrombectomy and aspiration, even though there are other devices designed to administer fibrinolytics and to perform thromboaspiration, rotational thrombectomy, rheolytic disruption, ultrasound thrombolysis, or mixed techniques [8][9][10][11][12]. Although controlled trials would be necessary to evaluate their effectiveness and safety, it is unlikely that they be carried out due to the patients' serious condition and the differences among the techniques used in each hospital [8][9][10][11][12]. In addition, apixaban was selected because there is evidence for efficacy (non-inferiority) and security (significantly fewer major bleeding events) as compared with warfarin [13].…”

Section: Discussionmentioning

confidence: 99%

Catheter-based Therapy for Massive Pulmonary Embolism in an Elderly Woman with Chest Pain and Dyspnea: Case Report

Ramos¹,

Ceballos²,

Alvarenga³

et al. 2019

Cureus

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An 80-year-old woman presented with chest pain and dyspnea. The electrocardiogram (ECG) showed a known chronic complete left bundle branch block and elevated levels of highsensitivity cardiac Troponin T. The first diagnosis was acute coronary syndrome, but a few hours later she developed shock and syncope; after resuscitation a coronary angiography was performed but it did not show any acute coronary obstruction. The echocardiogram showed McConnell's sign suggesting a massive pulmonary embolism; the pulmonary angiography showed large thrombi in both branches of pulmonary artery, so a catheter-based treatment was performed with thromboaspiration and rt-PA administration, and a significant improvement of blood pressure, clinical condition and right ventricle function was observed. In spite of bleeding at the puncture sites (femoral artery and vein), controlled by local compression, catheter-based therapy in massive pulmonary embolism was associated with survival and satisfactory outcome. A combined fragmentation/thromboaspiration and catheter-directed fibrinolysis strategy may be useful to reduce the embolic load, improve RV function, and reduce mortality.

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Section: Discussionmentioning

confidence: 99%

Catheter-based Therapy for Massive Pulmonary Embolism in an Elderly Woman with Chest Pain and Dyspnea: Case Report

Ramos¹,

Ceballos²,

Alvarenga³

et al. 2019

Cureus

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“…Pulmonary embolism (PE) is a leading cause of death worldwide. However, early diagnosis and subsequent initiation of anticoagulant treatment is of the utmost importance to reduce morbidity and mortality in these patients (4)(5)(6)(7)(8)(9). Especially since the widespread use of direct oral anticoagulant medication (10,11), treatment of PE is more feasible for both physicians and patients.…”

Section: Introductionmentioning

confidence: 99%

Significant increase in the incidence of high-risk pulmonary embolism during the COVID-19 shutdown: the pandemic response causes serious collateral consequences

Gressenberger

Gary

Raggam

et al. 2020

Preprint

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Background Strict stay-at-home rules, along with fear of coronavirus infection, have kept many patients from timely seeking medical attention during the novel coronavirus disease (COVID-19) pandemic. This situation may have led to an increase in the number of patients arriving at hospital in deteriorated clinical condition. In this regard, we aimed to investigate the incidence of pulmonary embolism (PE) patients defined as high-risk according to the European Society of Cardiology (ESC) presenting at our emergency department during the shutdown. Methods A retrospective data analysis explored the impact of the COVID-19 shutdown on the presentation of acute PE patients admitted to University Hospital Graz, Austria. We compared percentages of high-risk PE patients admitted during shutdown and during two control periods: the corresponding period in 2019 and an earlier period in 2020. By including data from the previous year, a general increase of high risk PE cases in 2020 compared to 2019 was ruled out. Risk assessment was carried out in accordance with current ESC guidelines for the diagnosis and management of acute PE. Results The percentage of patients with high-risk PE increased significantly during the COVID-19 shutdown period compared to the two control periods (p = 0.003; p = 0.011). Time from onset of symptoms to hospital admission was significantly longer in the study period compared to the control periods (p = 0.046 and p = 0.044, respectively). Conclusion The current findings indicate a significant increase in high-risk PE cases as well as delayed hospital admission of symptomatic PE patients during the COVID-19 shutdown period.

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“…Catheter directed therapies (CDTs) have revolutionised treatment of pulmonary embolism (PE). One popular device used with Food and Drug Administration (FDA) approval for PE is the EkoSonic system (BTG, West Conshohocken, PA, USA) 1 . Other currently available devices on the market for off label use in PE are the AngioVac and AngioJet system (AngioDynamics, Latham, NY, USA), and Indigo catheter (Penumbra Inc., Alameda, CA, USA) 1 .…”

Section: Introductionmentioning

confidence: 99%

“…One popular device used with Food and Drug Administration (FDA) approval for PE is the EkoSonic system (BTG, West Conshohocken, PA, USA) 1 . Other currently available devices on the market for off label use in PE are the AngioVac and AngioJet system (AngioDynamics, Latham, NY, USA), and Indigo catheter (Penumbra Inc., Alameda, CA, USA) 1 . These devices have their limitations, for example, the AngioJet system has been associated with dysrhythmias and the AngioVac system is large, difficult to manoeuvre to the pulmonary arteries, and is rarely used in modern practice 1 .…”

Section: Introductionmentioning

confidence: 99%

Right Atrial and Massive Pulmonary Artery Mechanical Thrombectomy Under Echocardiography Guidance Using the FlowTriever System

Chockalingam

Latich

Murali

et al. 2019

EJVES Short Reports

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IntroductionManagement of clot in transit in patients with pulmonary embolism, who are candidates for percutaneous intervention, can be challenging. This is a case report of simultaneous right atrial mechanical thrombectomy under echocardiography guidance and pulmonary artery embolectomy under fluoroscopy guidance, using the recently introduced FlowTriever system (Inari Medical Inc., Irvine, CA, USA).ReportAn 88 year old female, resuscitated from cardiopulmonary arrest near the end of a total right hip arthroplasty, presented for management of suspected massive pulmonary embolism. Her right atrial thrombus was removed under transthoracic echocardiography guidance, and her pulmonary arterial thrombus was subsequently successfully treated under fluoroscopy.DiscussionThe FlowTriever system can be safely and effectively used under real time transthoracic echocardiography guidance to retrieve clot in transit from the cardiac chambers, in addition to its standard application for the pulmonary artery under fluoroscopy guidance.

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Acute pulmonary embolism: endovascular therapy

Cited by 14 publications

References 45 publications

Catheter-based Therapy for Massive Pulmonary Embolism in an Elderly Woman with Chest Pain and Dyspnea: Case Report

Catheter-based Therapy for Massive Pulmonary Embolism in an Elderly Woman with Chest Pain and Dyspnea: Case Report

Significant increase in the incidence of high-risk pulmonary embolism during the COVID-19 shutdown: the pandemic response causes serious collateral consequences

Right Atrial and Massive Pulmonary Artery Mechanical Thrombectomy Under Echocardiography Guidance Using the FlowTriever System

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