Catheter-directed aspiration thrombectomy and low-dose thrombolysis for patients with acute unstable pulmonary embolism: Prospective outcomes from a PE registry

Gregorio, M.A. de; Guirola, Jose; Kuo, W.T.; Serrano, C. Sancho; Urbano, José; Figueredo, Ana L.; Sierre, Sergio; Quezada, Carlos; Barbero, Esther; Jiménez, David

doi:10.1016/j.ijcard.2019.02.061

Cited by 29 publications

(18 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Such studies are very often single-centre and based on a small number of cases. A few controlled, randomised trials have been performed, but with limited sample sizes and haemodynamic stability as the endpoint [5,33,43,44,45,46]. By contrast, available data does not support the routine use of systemic thrombolytic therapy or endovascular procedures for patients with intermediate-high-risk PE.…”

Section: Discussionmentioning

confidence: 99%

“…Straight and curved catheters are available to enhance efficacy. Preliminary tests in a small number of proximal PE patients have shown promising results, with haemodynamic improvement and an 80% survival rate [33]. -The FlowTriever System (Inari Medical) is a 3-component device consisting of a thrombectomy catheter with 3 nitinol disks, a retraction device for pushing and opening the disks into the clot, and a 20 F aspiration cannula (Figure 6).…”

Section: Ultrasound-assisted Catheter-directed Thrombolysismentioning

confidence: 99%

See 1 more Smart Citation

Endovascular therapies for pulmonary embolism

Rousseau

Giudice²,

Sanchez

et al. 2021

Heliyon

View full text Add to dashboard Cite

Purpose The aim of this article is to define the place of new endovascular methods for the management of pulmonary embolisms (PE), on the basis of a multidisciplinary consensus. Method and results Briefly, from the recent literature, for high-risk PE presenting with shock or cardiac arrest, systemic thrombolysis or embolectomy is recommended, while for lowrisk PE, anticoagulation alone is proposed. Normo-tense patients with PE but with biological or imaging signs of right heart dysfunction constitute a group known as “at intermediate risk” for which the therapeutic strategy remains controversial. In fact, some patients may require more aggressive treatment in addition to the anticoagulant treatment, because approximately 10% will decompensate hemodynamically with a high risk of mortality. Systemic thrombolysis may be an option, but with hemorrhagic risks, particularly intra cranial. Various hybrid pharmacomechanical approaches are proposed to maintain the benefits of thrombolysis while reducing its risks, but the overall clinical experience of these different techniques remains limited. Patients with high intermediate and high risk pulmonary embolism should be managed by a multidisciplinary team combining the skills of cardiologists, resuscitators, pneumologists, interventional radiologists and cardiac surgeons. Such a team can determine which intervention – thrombolysis alone or assisted, percutaneous mechanical fragmentation of the thrombus or surgical embolectomy – is best suited to a particular patient. Conclusions This consensus document define the place of endovascular thrombectomy based on an appropriate risk stratification of PE.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Ultrasound-assisted Catheter-directed Thrombolysismentioning

confidence: 99%

Endovascular therapies for pulmonary embolism

Rousseau

Giudice²,

Sanchez

et al. 2021

Heliyon

View full text Add to dashboard Cite

show abstract

“…To minimize the risk of bradycardia, 16 hypothetically caused by the release of adenosine from disrupted platelets, 17 our standard operation procedure (SOP) dictates that rheolytic fragmentation must be undertaken in short bursts of maximum 10 seconds while the cardiac rhythm is observed and normal frequency is secured. Optional small doses (5‐20 mg) of Alteplase were applied at the end of the procedures to exert best possible effect in fragmented or perforated thrombi 18,19 . Technical success was defined as reaching a desired position for fragmentation.…”

Section: Methodsmentioning

confidence: 99%

“…Optional small doses (5-20 mg) of Alteplase were applied at the end of the procedures to exert best possible effect in fragmented or perforated thrombi. 18,19 Technical success was defined as reaching a desired position for fragmentation. Procedural success was defined as technical success in the absence of major procedural complications.…”

Section: Editorial Commentmentioning

confidence: 99%

Outcomes of catheter‐directed interventions in high‐risk pulmonary embolism‐a retrospective analysis

Einarsson

Sandstrom

Svennerholm

et al. 2020

Acta Anaesthesiol Scand

View full text Add to dashboard Cite

Background: First-line treatment of high-risk pulmonary embolism with persistent hypotension and/or signs of shock is intravenous thrombolysis. However, if thrombolysis is contraindicated due to risk of serious bleeding, or if it yields insufficient effect, surgical thrombectomy or catheter-directed intervention (CDI) plus anticoagulation is recommended. The aim of this study was to assess the outcomes of the CDI modality introduced in a tertiary referral centre in 2013. Methods: Retrospective comparison between patients treated with CDI plus anticoagulation (n = 22) and patients treated with anticoagulation only (n = 23) as used before the CDI technique was available. The main outcomes of interest were 90day survival and reduction of right to left ventricle diameter (RV/LV) ratio, using the Fischer's exact test and a mixed model, respectively, for statistical analysis. Results: Ninety-day survival was 59% after CDI and 61% after anticoagulation only; P = .903. The rate of RV/LV ratio reduction was 0.4 units higher per 24 hours in the CDI group (median 2.1 pre-treatment), than in the anticoagulation only group (median 1.3 pre-treatment); P = .007. Conclusion: In patients with high-risk pulmonary embolism, 90-day survival was similar after treatment with CDI plus anticoagulation compared to anticoagulation only. The mean reduction in RV/LV ratio was larger in the CDI group. Our results support the use of CDI in selected patients, respecting the limitations and potential side effects of each technical device used. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

show abstract

“…2015ean argitaratutako PERFECT (23) eta SEATTLE II (24) ikerketa multizentrikoek guk hartutako bidea indartu zuten, zeintzuetan lehen emaitza onak izan zituzten egonkortze hemodinamikoari, birika-arteriako presioa gutxitzeari eta biziraupenari zegokienez, konplikazio hemorragia kointrakranealik antzeman gabe. Orduz geroztik asko ugaritu dira gai honi buruzko berrikuspenak, metaanalisiak eta ikerketa berriak, zeintzuek hemorragia-arrisku altuko BTE akutu larrien (25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36) tratamendurako kateter bidez gidatutako teknika berrien eraginkortasuna egiaztatzen jarraitzen duten, bai eta tronboen xurgaketarako gailu eraginkorragoenak ere, FlowTriever System (Inari)® (33) edo Indigo System (Penumbra)® (25) bezalakoak esaterako.…”

Section: Eztabaida Eta Ondorioakunclassified

GITEPen 5 urteko esperientzia Gipuzkoan: diziplina anitzeko taldea biriketako tronboenbolismo akutu larriaren artatze integralerako

Jaka

Ibarraran

Jimenez

et al. 2021

Osag

View full text Add to dashboard Cite

Sarrera: 2012ko urtarrilean GiTEP diziplina anitzeko taldea eratu zenbiriketako tronboenbolismo akutu larriaren tratamendurako, Gipuzkoan, 800.000 biztanleko eremuan. Helburua prozesu honetan inplikatutako zerbitzuen arteko koordinazioa hobetzea zen, erantzun azkarrago, aktiboago, osoago eta indibidualizatuago bat emanaz.Material eta metodoak: GiTEPek barne hartzen ditu medikuntza intentsiboko, kardiologia interbentzionistako, bihotzeko kirurgiako, pneumologiako, erradiodiagnostikoko, erradiologia interbentzionistako, larrialdietako, hematologiako eta onkologiako espezialistak. 2012ko urriaren eta 2016ko abenduaren artean ingresatutako pazienteen ezaugarri demografikoak, tratamendua eta lehen 6 hilabeteetako bilakaera aztertu ziren.Emaitzak: Denbora-tarte horretan 178 paziente ingresatu ziren biriketako tronboenbolismoagatik Gipuzkoako zainketa intentsiboen unitateetan, European Society of Cardiologyren 2014ko sailkapenaren arabera estratifikatuta. Horietatik, 124 pazientetan (% 70) aktibatu zen GiTEPKodea, eta horien artean 35 arrisku handikoak eta 89 arrisku ertain-altukoak izan ziren. Batez besteko adina 65 urtekoa izan zen, eta % 50,6 gizonak izan ziren. Gehien erabili zen tratamendua antikoagulazioa izan zen (% 57,3). Birperfusio aurreraturako, kateter bidez gidatutako teknika farmakoinbasiboa (% 28,1) eta rtPA bidezko fibrinolisi sistemikoa (% 12,4) erabili ziren. Ez zen inor ebakuntza bidez tratatu. % 6,7k konplikazio hemorragikoak izan zituen, bat bera ere ez bizi-arriskukoa edo intrakraneala. ZIUko egonaldiaren mediana 3 egunekoa izan zen, eta ospitalekoarena 9 egunekoa. 30 egunerako hilkortasuna% 6,2koa izan zen. Eztabaida eta ondorioak: Biriketako tronboenbolismo larriaren diziplina anitzeko kudeaketak paziente hauen tratamendurako jarrera proaktiboago eta antolatuago bat ahalbidetu du, konplikazio hemorragiko larririk gabe eta espero baino hilkortasun txikiagoarekin.

show abstract

Catheter-directed aspiration thrombectomy and low-dose thrombolysis for patients with acute unstable pulmonary embolism: Prospective outcomes from a PE registry

Cited by 29 publications

References 23 publications

Endovascular therapies for pulmonary embolism

Endovascular therapies for pulmonary embolism

Outcomes of catheter‐directed interventions in high‐risk pulmonary embolism‐a retrospective analysis

GITEPen 5 urteko esperientzia Gipuzkoan: diziplina anitzeko taldea biriketako tronboenbolismo akutu larriaren artatze integralerako

Contact Info

Product

Resources

About