Catheter-Directed Thrombolytic Intervention Is Effective for Patients with Massive and Submassive Pulmonary Embolism

Akin, H.; Al-Jubouri, Mustafa; Assi, Zakaria; Sepanski, Deb; Comerota, Anthony J.

doi:10.1016/j.avsg.2014.05.004

Cited by 15 publications

(6 citation statements)

References 13 publications

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“…The studies demonstrated improved RV function, decreased intracranial hemorrhage, and similar mortality and morbidity compared to systemic thrombolysis. [5][6][7][8][9][10]12 Yet, additional evidence and studies are needed in the short-and long-term on CDT before the intervention can be deemed the standard of care compared to systemic thrombolysis. For patients with massive and submassive PE, CDT does play a role in clinical application.…”

Section: Discussionmentioning

confidence: 99%

“…5,6 Recent advances in endovascular technology have seen the use of CDT to reverse right heart dysfunction utilizing a smaller dose of thrombolytics. [6][7][8][9][10][11][12][13][14][15][16][17][18][19] EkoSonic catheters (EKOS Corporation, Bothell, WA, United States) employ ultrasound vibrators to assist in clot dissolution and are currently the only Food and Drug Administration (FDA)-approved device for PE CDT. [19][20][21][22][23][24][25][26][27] Proponents of CDT for submassive PE highlight the efficacy of EkoSonic Endovascular System (EKOS) in reversing acute right heart dysfunction after PE.…”

Section: Introductionmentioning

confidence: 99%

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Protocolized use of catheter-directed thrombolysis and echocardiography is highly effective in reversing acute right heart dysfunction in severe submassive pulmonary embolism patients

et al. 2020

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Objective: The objective of this study was to evaluate the efficacy of protocolized use of catheter-directed thrombolysis and echocardiography in submassive pulmonary embolism patients. Methods: A retrospective study at a single institution of 28 patients that presented with submassive pulmonary embolism from July 2016 to September 2019 was performed. All patients were diagnosed using chest computed tomography demonstrating a pulmonary embolism and abnormal right ventricular to left ventricular ratio. Patients with severe right heart dysfunction (right ventricular to left ventricular ratio ⩾1.4) were protocolized to receive catheter-directed thrombolysis via EkoSonic catheters (EKOS Corporation, Bothell, WA, United States). Transthoracic echocardiogram was performed after 24 hours to assess right ventricular function and determine the need to continue thrombolysis. Patients after discharge then received follow-up echocardiograms at 6 weeks to determine new post-treatment baseline. Results: The mean patient age was 54.6 years, mean body mass index was 35.0, and mean right ventricular to left ventricular ratio on admission computed tomography imaging was 1.70. Interval mean right ventricular to left ventricular ratio on echocardiography during thrombolysis therapy was 1.01 (p < 0.00001). Patients were tachycardic on admission (mean heart rate 102.2 beats per minute) with improvement by completion of thrombolysis (mean heart rate 72.9 beats per minute) (p < 0.00001). There was a 0% incidence of periprocedural complications. Overall 30-day complication rate was 7.1% (n = 1 arrhythmia, n = 1 delayed intracranial hemorrhage). At 6-week follow-up, 91% of the patients who received echocardiography had normal right ventricular function. Conclusion: This retrospective study demonstrates the effectiveness of protocolized use of catheter-directed thrombolysis and echocardiography in reversing severe right heart dysfunction in submassive pulmonary embolism patients.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Protocolized use of catheter-directed thrombolysis and echocardiography is highly effective in reversing acute right heart dysfunction in severe submassive pulmonary embolism patients

et al. 2020

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“…The expansion of endovascular technology has seen the growing use of CDT to address submassive and massive PE. [5][6][7] The general aim of CDT in the setting of compromised hemodynamics or cardiac function with acute PE is to debulk or redistribute the obstructive clot. This has facilitated less invasive but still highly effective interventions in patients, even those with more severe PEs.…”

Section: Discussionmentioning

confidence: 99%

“…3 Advancement in endovascular technology has seen the use of catheter-directed thrombolysis (CDT) to reverse right heart dysfunction utilizing a localized and smaller dose of thrombolytics. [4][5][6][7][8][9] The most common catheter-based system is the EkoSonic catheters (EKOS Corporation, Bothell, Washington), the only Food and Drug Administration (FDA)-approved catheter-based system for acute PE intervention. 4,[10][11][12][13] This case series demonstrates that for a select population of patients with severe submassive PE, the use of CDT and echocardiography monitoring can facilitate same-day discharge from the intensive care unit (ICU).…”

Section: Introductionmentioning

confidence: 99%

Same-Day ICU Discharge in Selected Patients With Severe Submassive Pulmonary Embolism Treated With Catheter-Directed Thrombolysis

Gupta

Marek

Rana

et al. 2019

Vasc Endovascular Surg

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A retrospective review from July 2016 to April 2018 was performed of 23 patients with submassive pulmonary embolism (PE) who received catheter-directed thrombolysis (CDT). Five (22%) of the 23 patients were discharged the same day from the intensive care unit (ICU) following thrombolysis completion. Their presentation, hospital courses, complications, and follow-up are reviewed. All 5 patients were diagnosed using chest computed tomography (CT) demonstrating a clot in the pulmonary vasculature and right ventricle dysfunction based on abnormal right ventricle to left ventricle (RV/LV) ratio. Patients with severe right heart dysfunction (RV/LV ratio ≥1.4) were protocolized to receive CDT via EkoSonic catheters (EKOS Corporation). Postoperatively, patients were admitted to the ICU with continuous alteplase at 1 mg/h. Echocardiography was then performed after 24 hours of therapy to assess right ventricle function and removal of EkoSonic catheters. Patients with reversal of right heart dysfunction and symptomatic improvement received bedside removal of catheters. The mean patient age was 50.6 years and body mass index was 33.6. Mean RV/LV ratio on admission via CT imaging was 1.56, with a mean troponin of 0.44. Interval mean RV/LV ratio on echocardiography after thrombolysis therapy was 0.91. There was a 0% incidence of periprocedural complications. One (20%) patient out of 5 had an emergency department visit 10 days postdischarge for acute shortness of breath, with workup revealing no evidence of recurrent PE. No patient required hospital readmission within 30 days. At the 6-week follow-up, all patients had continued normal right ventricular function noted on echocardiography. This case series demonstrates that for a select population of patients with severe submassive PE, the use of CDT and echocardiography monitoring can facilitate same-day discharge from the ICU.

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“…Additionally, the short term benefits of CDT in massive and submassive PE have shown promising results in the form of improved RV function, decreased pulmonary artery pressures and decreased hospitalization days compared to those patients receiving anticoagulation only. There have been numerous retrospective reviews demonstrating the short term benefits of CDTs in massive and submassive PE (30)(31)(32)(33)(34). However, the long term benefits of CDT in the submassive population have not been evaluated in a prospective study.…”

Section: Future Trends For Cdt In Pementioning

confidence: 99%

Rationale for catheter directed therapy in pulmonary embolism

Naidu¹,

Knuttinen²,

Kriegshauser³

et al. 2017

Cardiovasc. Diagn. Ther.

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Pulmonary embolism (PE) is a widespread health concern associated with major morbidity and mortality. Catheter directed therapy (CDT) has emerged as a treatment option for acute PE adding to the current potential options of systemic thrombolysis or anticoagulation. The purpose of this review is to understand the rationale and indications for CDT in patients with PE. While numerous studies have shown the benefits of systemic thrombolysis compared to standard anticoagulation, these are balanced by the increased risk of major bleeding. With this in mind, CDT has the potential to offer the benefits of systemic thrombolysis and in theory, a reduced risk of bleeding. This article will review current treatment guidelines in both massive and submassive PE evaluating both short and long term benefits. The role of CDT will be highlighted, with an emphasis on efficacy and safety.

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Catheter-Directed Thrombolytic Intervention Is Effective for Patients with Massive and Submassive Pulmonary Embolism

Cited by 15 publications

References 13 publications

Protocolized use of catheter-directed thrombolysis and echocardiography is highly effective in reversing acute right heart dysfunction in severe submassive pulmonary embolism patients

Protocolized use of catheter-directed thrombolysis and echocardiography is highly effective in reversing acute right heart dysfunction in severe submassive pulmonary embolism patients

Same-Day ICU Discharge in Selected Patients With Severe Submassive Pulmonary Embolism Treated With Catheter-Directed Thrombolysis

Rationale for catheter directed therapy in pulmonary embolism

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