Catheter-Based Therapies Decrease Mortality in Patients With Intermediate and High-Risk Pulmonary Embolism: Evidence From Meta-Analysis of 65,589 Patients

Pietrasik, Arkadiusz; Szarpak, Łukasz; Pruc, Michał; Kopiec, Tomasz; Darocha, Szymon; Banaszkiewicz, Marta; Niewada, Maciej; Grabowski, Marcin; Kurzyna, Marcin

doi:10.3389/fcvm.2022.861307

Cited by 17 publications

(6 citation statements)

References 42 publications

(69 reference statements)

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“…A recent meta-analysis of 65 589 patients with PE treated with catheter-based therapy (CDMT or catheter-directed thrombolysis) or ST demonstrated a significantly lower 28–30-day mortality in patients treated with percutaneous techniques vs. ST (7.3% vs. 13.6%). 29 …”

Section: Discussionmentioning

confidence: 99%

Catheter-directed mechanical aspiration thrombectomy in a real-world pulmonary embolism population: a multicenter registry

Sławek-Szmyt

Stępniewski

Kurzyna³

et al. 2023

European Heart Journal: Acute Cardiovascular Care

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Background High- (HR) and intermediate-high risk (IHR) pulmonary embolisms (PEs) are related to high early mortality and long-term sequelae. We aimed to describe clinical outcomes and adverse events in IHR and HR PE treated with catheter-directed mechanical thrombectomy (CDMT) in a real-world population. Methods This study is a multicenter, prospective registry enrolling 110 PE patients treated with CDMT between 2019 and 2022. The CDMT was performed using the 8F Indigo (Penumbra, Alameda, US) system bilaterally in pulmonary arteries (PAs). The primary safety endpoints included device or PE-related death during the 48-hour after CDMT, procedure-related major bleeding, or other major adverse events. Secondary safety outcomes were all-cause mortality during hospitalization or the follow-up. The primary efficacy outcomes were the reduction of PA pressures and change in the RV-to-left ventricular (RV/L) ratio assessed in the imaging 24-48 hours after the CDMT. Results 71.8% of patients had IHR PE and 28.2% HR PE. 11.8% of patients had a failure and 34.5% had contraindications to thrombolysis, and 2.7% had polytrauma. There was 0.9% intraprocedural death related to RV failure and 5.5% deaths within the first 48 hours. CDMT was complicated by major bleeding in 1.8, pulmonary artery injury in 1.8%, and ischemic stroke in 0.9%. Immediate hemodynamic improvements included a 10.4 ± 7.8 mmHg (19.7%) drop in systolic PAP (p < 0.0001), a 6.1 ± 4.2 mmHg (18.8%) drop in mean PAP, and 0.48 ± 0.4 (36%) drop in RV/LV ratio (p < 0.0001). Conclusions These observational findings suggest that CDMT may improve hemodynamics with an acceptable safety profile in patients with IHR and HR PE.

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Section: Discussionmentioning

confidence: 99%

Catheter-directed mechanical aspiration thrombectomy in a real-world pulmonary embolism population: a multicenter registry

Sławek-Szmyt

Stępniewski

Kurzyna³

et al. 2023

European Heart Journal: Acute Cardiovascular Care

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“…In a previously published meta-analysis of 11 studies including 65,589 patients, 30-day mortality was 2-fold lower in the CDTx group than in the ST group (7.3 vs. 13.6%; odds ratio [OR]: 0.51, 95% confidence interval [CI]: 0.38–0.69, p < 0.001). The rates of adverse events such as myocardial injury, cardiac arrest, stroke, and major bleeding complications were lower in the CDTx group compared to the ST group (p < 0.001 for all) [ 26 ]. In the present publication, patients treated with CDTx accounted for 7% of all PERT consultations (17/240), with 8 out of 17 (47%) patients in the HR group.…”

Section: Discussionmentioning

confidence: 99%

Treatment of high- and intermediate-high-risk pulmonary embolism by the Pulmonary Embolism Response Team: Focus on catheter-directed therapies

Pietrasik

Kurzyna

Szwed³

et al. 2024

Cardiol J.

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Background Multidisciplinary Pulmonary Embolism Response Teams (PERTs) were established to individualize the treatment of high-risk (HR) and intermediate-high-risk (IHR) pulmonary embolism (PE) patients, which pose a challenge in clinical practice. Methods We retrospectively collected the data of all HR and IHR acute PE patients consulted by PERT CELZAT between September 2017 and October 2022. The patient population was divided into four different treatment methods: anticoagulation alone (AC), systemic thrombolysis (ST), surgical embolectomy (SE), and catheter-directed therapies (CDTx). Baseline clinical characteristics, risk stratification, PE severity parameters, and treatment outcomes were compared between the four groups. Results Of the 110 patients with HR and IHR PE, 67 (61%) patients were treated with AC only, 11 (10%) with ST, 15 (14%) underwent SE, and 17 (15%) were treated with CTDx. The most common treatment option in the HR group was reperfusion therapy, used in 20/24 (83%) cases, including ST in 7 (29%) patients, SE in 5 (21%) patients, and CTDx in 8 (33%) patients. In contrast, IHR patients were treated with AC alone in 63/86 (73%) cases. The in-hospital mortality rate was 9/24 (37.5%) in the HR group and 4/86 (4.7%) in the IHR group. Conclusions The number of advanced procedures aimed at reperfusion was substantially higher in the HR group than in the IHR PE group. Despite the common use of advanced reperfusion techniques in the HR group, patient mortality remained high. There is a need further to optimize the treatment of patients with HR PE to improve outcomes.

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“…In recent years, there has been a rise in interest in catheter-based mechanical thrombectomy because of its reduced bleeding risk compared to thrombolytics [ 21 ]. Iodinated contrast is used during mechanical thrombectomy [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

Role of Intravascular Ultrasound in Pulmonary Embolism Patients Undergoing Mechanical Thrombectomy: A Systematic Review

Desai

Raval²,

Adompreh-Fia³

et al. 2023

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Background: Traditionally, mechanical thrombectomy performed for pulmonary embolism (PE) necessitates the utilization of iodinated contrast. Intravascular ultrasound (IVUS) has been used as a diagnostic and therapeutic modality in the management of acute high and intermediate-risk PE. Recently, with the shortage of contrast supplies and the considerable incidence of contrast-induced acute kidney injury (CI-AKI), other safer and more feasible IVUS methods have become desirable. The purpose of this systematic review was to evaluate the importance of IVUS in patients with PE undergoing thrombectomy. Methods: Medline/PubMed, Embase, Scopus, and Google Scholar were searched for review studies, case reports, and case series. Clinical characteristics, outcomes and the usage of IVUS-guided mechanical thrombectomy during the treatment of acute high and intermediate-risk PE were examined in a descriptive analysis. Results: In this systematic review, we included one prospective study, two case series, and two case reports from July 2019 to May 2023. A total of 39 patients were evaluated; most were female (53.8%). The main presenting symptoms were dyspnea and chest pain (79.5%); three patients (7.9%) presented with syncope, one with shock and one with cardiac arrest. Biomarkers (troponin and BNP) were elevated in 94.6% of patients. Most patients (87.2%) had intermediate-risk PE, and 12.8% had high-risk PE. All patients presented with right-heart strain (RV/LV ratio ≥ 0.9, n = 39). Most patients (56.4%) had bilateral PE. Mechanical thrombectomy was performed using IVUS without contrast utilization in 39.4% of the patients. After the initial learning curve, contrast usage decreased gradually over time. There was a significant decrease in the composite mean arterial pressure immediately following IVUS-guided thrombectomy from 35.1 ± 7.2 to 25.2 ± 8.3 mmHg (p < 0.001). Post-procedure, there was no reported (0%) CI-AKI, no all-cause mortality, no major bleeding, or other adverse events. There was a significant improvement in symptoms and RV function at the mean follow-up. Conclusions: New evidence suggests that IVUS-guided mechanical thrombectomy is safe, with visualization of the thrombus for optimal intervention, and reduces contrast exposure.

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Catheter-Based Therapies Decrease Mortality in Patients With Intermediate and High-Risk Pulmonary Embolism: Evidence From Meta-Analysis of 65,589 Patients

Cited by 17 publications

References 42 publications

Catheter-directed mechanical aspiration thrombectomy in a real-world pulmonary embolism population: a multicenter registry

Catheter-directed mechanical aspiration thrombectomy in a real-world pulmonary embolism population: a multicenter registry

Treatment of high- and intermediate-high-risk pulmonary embolism by the Pulmonary Embolism Response Team: Focus on catheter-directed therapies

Role of Intravascular Ultrasound in Pulmonary Embolism Patients Undergoing Mechanical Thrombectomy: A Systematic Review

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