Catheter-directed therapy to treat intermediateand high-risk pulmonary embolism: Personal experience and review of the literature

Pietrasik, Arkadiusz; Kotulecki, Aleksander; Karolak, Paulina; Araszkiewicz, Aleksander; Darocha, Szymon; Grabowski, Marcin; Kurzyna, Marcin

doi:10.5603/cj.a2022.0075

Cited by 4 publications

(4 citation statements)

References 41 publications

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“…Of note 40% (38 patients) of IHRPE patients were referred for CDT as the primary reperfusion option. In this group time between PE diagnosis and CDT was 5 (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20) hours.…”

Section: Patient Characteristicsmentioning

confidence: 77%

“…There is growing clinical evidence on catheter-directed therapies (CDT) for the treatment of acute PE. Currently a wide range of systems and techniques for CDT are available including clot fragmentation, mechanical embolectomy, local thrombolysis, and combined pharmaco-mechanical thrombus fragmentation [5][6][7]. A multicenter, investigator initiated European Database on Catheter Directed Therapy of Pulmonary Embolism (EuroPE-CDT) has been organized in order to assess the currently applied CDT techniques in real life and to determine in--hospital mortality, efficacy and safety of this invasive procedure.…”

Section: Introductionmentioning

confidence: 99%

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Initial results of investigator initiated international database on catheter directed therapy of acute pulmonary embolism

Jermakow,

Obradovic,

Salinas

et al. 2024

Cardiol J.

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Background: Catheter directed therapies (CDT) are widely used in the treatment of acute pulmonary embolism (PE). A multicenter registry was organized to evaluate their application in real life and to determine efficacy and safety of these procedures. Local experience of participating centers in percutaneous techniques for PE treatment was assessed. Methods: An internet-based registry was designed to collect clinical, echocardiographic and laboratory data of consecutive PE patients treated with CDT in participating centers between 2017 and 2022. Results: Under analysis were 145 consecutive patients with acute PE, aged 61 ± 15 years, treated with CDT in 7 centers: 50 (34.5%) patients with high-risk PE (HRPE), and 95 (65.5%) patients with intermediate-high risk PE (IHRPE). 100 (69%) patients were treated with dedicated devices, in 45 (31%) subjects a pigtail catheter was used. Total PE or CDT related in-hospital mortality in HRPE reached 14% (7 patients), while in IHRPE 3.2% (3 patients) (p = 0.032). 50% of PE or CDT related deaths occurred in patients treated with a pigtail catheter. All-cause mortality in 145 patients was 9.7%, and it was higher in HRPE than in IHRPE (18% vs. 5.3%, p = 0.019). The use of pigtail catheters compared to dedicated systems was associated with higher mortality (20% vs. 5%, p = 0.01). Conclusions: Catheter directed therapies is a real option of treating PE. It was used as primary therapy also in patients without contraindication for thrombolysis suggesting that clinical practice does not always follow current PE guidelines. Patients treated with dedicated CDT systems had a higher survival rate than subjects treated with pigtail catheters.

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Section: Patient Characteristicsmentioning

confidence: 77%

Section: Introductionmentioning

confidence: 99%

Initial results of investigator initiated international database on catheter directed therapy of acute pulmonary embolism

Jermakow,

Obradovic,

Salinas

et al. 2024

Cardiol J.

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“…Cleaner XT TM is a 6 F rotational thrombectomy system, utilizing a sinuous-shaped radio-opaque wire that rotates at approximately 4000 rounds per minute, facilitating gentle mechanical declotting [ 21 ]. Details of the CDTx methods applied by our PERT have previously been described [ 22 ].…”

Section: Methodsmentioning

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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“…CDT should also be considered in patients in whom ST has not been effective. A recent meta-analysis showed that CDT can reduce the risk of in-hospital death [30] compared with ST.…”

Section: Catheter-directed Treatment In the Management Algorithm For ...mentioning

confidence: 99%

Role of catheter-directed therapies in the treatment of acute pulmonary embolism. Expert opinion of the Polish PERT Initiative, Working Group on Pulmonary Circulation, Association of Cardiovascular Interventions, and Association of Intensive Cardiac Care of the Polish Cardiac Society

Kopeć

Araszkiewicz

Kurzyna³

et al. 2023

Kardiol Pol

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Acute high-risk PE with contraindications to ST or after ineffective ST Acute intermediate-high-risk PE with clinical and hemodynamic deterioration during anticoagulant treatment -clinical, imaging, and/or laboratory data indicating worsening of PE (Table 4) Acute intermediate-high-risk PE without clinical and hemodynamic improvement despite anticoagulant therapy-clinical, imaging, and/or laboratory data indicating persistence of PE (Table 4) Acute intermediate-high-risk PE with absolute contraindications to ST Acute PE with a thrombus in the RV, the so-called thrombus in transit, including the presence of a thrombus passing through the PFO/ASD Acute PE with coexisting symptoms of paradoxical embolism such as acute myocardial infarction, ischemic stroke Acute high-risk or intermediate-high-risk PE in a pregnant patient Acute nonthrombotic PE (e.g., fat embolism, amniotic fluid, iatrogenic embolism) Acute PE superimposed on chronic thromboembolic pulmonary hypertension

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Catheter-directed therapy to treat intermediateand high-risk pulmonary embolism: Personal experience and review of the literature

Abstract: This article has been peer reviewed and published immediately upon acceptance.It is an open access article, which means that it can be downloaded, printed, and distributed freely, provided the work is properly cited. Articles in "Cardiology Journal" are listed in PubMed.

Cited by 4 publications

References 41 publications

Initial results of investigator initiated international database on catheter directed therapy of acute pulmonary embolism

Initial results of investigator initiated international database on catheter directed therapy of acute pulmonary embolism

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

Role of catheter-directed therapies in the treatment of acute pulmonary embolism. Expert opinion of the Polish PERT Initiative, Working Group on Pulmonary Circulation, Association of Cardiovascular Interventions, and Association of Intensive Cardiac Care of the Polish Cardiac Society

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