Catheter-directed therapies for the treatment of high risk (massive) and intermediate risk (submassive) acute pulmonary embolism

Harvey, John Julian; Huang, Shi‐Wei; Uberoi, Raman

doi:10.1002/14651858.cd013083.pub2

Cited by 14 publications

(19 citation statements)

References 86 publications

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“…The rate of in-hospital mortality in hemodynamically unstable patients is high and reported to reach nearly 32% ( 5 ). Patients with PE are classified according to the short-term risk of mortality, that is based on clinical characteristics, laboratory tests and imaging findings: high-risk PE, defined by a 30-days risk of mortality >10%, accounts for less than 10% of PE cases and represents a life-threatening medical emergency, requiring immediate reperfusion treatment to prevent death ( 6 ); intermediate-risk PE patients are defined as hemodynamically stable, but they should be rigorously monitored, because some can deteriorate and eventually require reperfusion therapy ( 7 ).…”

Section: Discussionmentioning

confidence: 99%

Successful percutaneous catheter-directed treatment of high-risk pulmonary embolism: a case report

Russo¹,

Massaro²,

Sangiorgi³

2023

AME Case Rep

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Background Pulmonary embolism (PE) is an acute cardiovascular syndrome characterized by high incidence and mortality. The therapy of this condition is based on anticoagulation and hemodynamic support, but in case of high-risk mortality, the European Society of Cardiology (ESC) guidelines recommend systemic thrombolytic therapy and surgical embolectomy if thrombolysis is contraindicated or has failed; nowadays several percutaneous catheter-directed treatments for local thrombolysis or mechanical embolectomy are available, but they have IIa class of recommendation, because of lack of robust scientific evidence favoring their use. Case Description We described a case of high-risk PE treated with a novel percutaneous system for mechanical embolectomy, which consists of a large aspiration catheter that was advanced in the pulmonary artery, capturing and removing a vast thrombus, of 15 centimeters in length. This therapeutic strategy avoided the risk of hemorrhagic complications related to systemic thrombolysis, exiting in the achievement of fast patient hemodynamic stabilization and symptoms resolution, without complications. Computed tomography (CT) pulmonary angiography after 10 days from the intervention revealed the complete resolution of pulmonary artery filling defects, and the patient was discharged asymptomatic. Conclusions Percutaneous catheter-directed treatments represent an effective alternative therapy for PE, but further studies are needed to demonstrate safety and superiority over the actually recommended therapy.

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Section: Discussionmentioning

confidence: 99%

Successful percutaneous catheter-directed treatment of high-risk pulmonary embolism: a case report

Russo¹,

Massaro²,

Sangiorgi³

2023

AME Case Rep

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“…Echocardiographic evidence suggests an incidence of 30%–70% of normotensive individuals with PE will have right ventricular strain. In such cases, treatment involves the use of systemic tissue plasminogen activator (tPA) or mechanical thrombectomy depending on patient presentation and facility experience 2,3 . However, guidelines poorly define the next steps in intervention if mechanical thrombectomy were to fail 4 .…”

Section: Introductionmentioning

confidence: 99%

Catheter‐directed thrombolysis as an emergent intervention for failed vacuum thrombectomy of pulmonary embolism

Haq

Hinegardner‐Hendricks

Cole

et al. 2023

Respirology Case Reports

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Acute pulmonary embolism [PE] in the setting of hemodynamic instability and right ventricular strain is a complex presentation and typically is associated with high mortality rates. Prompt recognition and early intervention are critical to the survival of these patient. In such cases, current guidelines recommend use of systemic thrombolytics, along with as needed cardiopulmonary support. If contraindications are present, mechanical thrombectomy is advised. However, guidelines poorly define the next steps in intervention if mechanical thrombectomy were to fail. We present such a scenario and the methods implored to successful remove clot burden. We add to the literature, use of catheter directed thrombolysis at a designated 2 mg/h rate as a form of emergent intervention in failed mechanical thrombectomy.

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“…However, management strategies for acute PE vary in children due to a lack of standard guidelines. In adults, pulmonary artery-catheter-directed thrombolysis and catheter embolectomy are potentially effective therapeutic options [ 6 ]. Catheter-directed thrombolysis has been described and is feasible in children, but the experience is limited [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Successful Pulmonary Endarterectomy after Acute Pulmonary Embolism and Reversal of Acute Cor Pulmonale in an 11-Year-Old Boy with Nephrotic Syndrome

Osakwe

Das

2022

Children

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Patients with nephrotic syndrome (NS) are at an increased risk for thromboembolic events, such as deep venous and arterial thrombosis and pulmonary embolism (PE). In general, PE in children differs from adults in incidence, predisposition, pathophysiology, presenting symptoms, and management strategies. There is a lack of treatment guidelines for PE in children, and the management strategies are mostly extrapolated from adult data. This case report highlights the presentation of acute cor pulmonale due to massive PE associated with NS and a successful pulmonary endarterectomy that reversed the child’s pulmonary hypertension and normalized right ventricular function.

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Catheter-directed therapies for the treatment of high risk (massive) and intermediate risk (submassive) acute pulmonary embolism

Cited by 14 publications

References 86 publications

Successful percutaneous catheter-directed treatment of high-risk pulmonary embolism: a case report

Successful percutaneous catheter-directed treatment of high-risk pulmonary embolism: a case report

Catheter‐directed thrombolysis as an emergent intervention for failed vacuum thrombectomy of pulmonary embolism

Successful Pulmonary Endarterectomy after Acute Pulmonary Embolism and Reversal of Acute Cor Pulmonale in an 11-Year-Old Boy with Nephrotic Syndrome

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