Catheter-directed ultrasound-accelerated thrombolysis may be life-saving in patients with massive pulmonary embolism after failed systemic thrombolysis

Sağ, Saim; Nas, Ömer Fatih; Kaderli, Aysel Aydin; Özdemi̇r, Bülent; Baran, İbrahim; Erdoğan, Cüneyt; Güllülü, Sümeyye; Hakyemez, Bahattin; Aydınlar, Ali

doi:10.1007/s11239-016-1370-3

Cited by 19 publications

(8 citation statements)

References 18 publications

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“…Conversely, if further pharmacologic thrombolysis is desired following primary PMT, an extended thrombolytic infusion can still be performed. 19,20 Even more, after fragmentation, a greater surface area of thrombus can be exposed to the thrombolytic; consequently, less drug and perhaps less time is needed to achieve thrombolysis. However, although we failed to show any difference hospital survival in patients with or without thrombolytic therapy, there is a trend to increased mortality in patients who received thrombolysis.…”

Section: Discussionmentioning

confidence: 99%

Percutaneous mechanical thrombectomy in patients with high-risk pulmonary embolism and contraindications for thrombolytic therapy

Bunc

Steblovnik

Zorman

et al. 2020

Radiology and Oncology

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BackgroundHigh-risk pulmonary embolism is associated with a high early mortality rate. We report our experience with percutaneous mechanical thrombectomy in patients with high-risk pulmonary embolism and contraindications for thrombolytic therapy.Patients and methodsThis was a retrospective analysis of consecutive patients with high-risk pulmonary embolism and contraindications to thrombolytic therapy. They were treated with percutaneous mechanical thrombectomy which included thrombectomy and additional thrombus aspiration when needed. Clinical parameters and survival to discharge were measured.ResultsFrom November 2005 to September 2015 we treated 25 patients with a mean age of 62.6 ± 12.7 years, 64% were men. Mean simplified Pulmonary Embolism Severity Index was 2.9. Mean maximum lactate levels were 7.8 ± 6.6 mmol/L, vasopressors were used in 77%, and 59% needed mechanical ventilation. Mechanical treatment included thrombus fragmentation complemented with aspiration (56%) and aspiration using Aspirex®S catheter (44%). Local (5 patients; 20%) and systemic (3 patients; 12%) thrombolytics were used as a salvage therapy. We observed nonsignificant improvements in systemic blood pressure (100 ± 41 mm Hg vs 119 ± 34; p = 0.100) and heart frequency (99 ± 35 min-1vs 87 ± 31 min-1; p = 0.326) before and after treatment, respectively. Peak systolic tricuspid pressure gradient was significantly lower after treatment (57 ± 14 mm Hg vs 31 ± 3 mm Hg; p = 0.018). Overall the procedure was technically successful in 20 patients (80%) and 17 patients (68%) survived to hospital discharge.ConclusionsIn patients with high-risk pulmonary embolism who cannot receive thrombolytic therapy, percutaneous mechanical thrombectomy is a promising alternative to reduce pulmonary artery pressure.

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Section: Discussionmentioning

confidence: 99%

Percutaneous mechanical thrombectomy in patients with high-risk pulmonary embolism and contraindications for thrombolytic therapy

Bunc

Steblovnik

Zorman

et al. 2020

Radiology and Oncology

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“…32 Catheter-directed thrombolysis has proved lifesaving in patients with failure of systemic thrombolysis. 33 We believe the time is rapidly approaching for the implementation of CDT as a first-line therapy for submassive PE. We demonstrate the efficacy of ultrasound-assisted CDT in significantly lowering pulmonary vascular obstruction ( Figure 2) and right ventricular strain (Figure 3) as well as reversing right ventricular hypokinesis and dilation.…”

Section: Discussionmentioning

confidence: 99%

Ultrasound-Assisted Catheter-Directed Thrombolysis for Submassive Pulmonary Embolism

Mohan

Manov

Contreras

et al. 2018

Vasc Endovascular Surg

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Catheter-directed thrombolysis is an effective therapy in rapidly alleviating the right heart strain that is associated with increased mortality and long-term morbidity in patients with pulmonary embolism with minimal bleeding risk. Catheter-directed thrombolysis is a safe alternative to systemic thrombolysis in patients with risk factors for bleeding such as prior surgery. Future studies should examine the safety of CDT in patients with contraindications to systemic thrombolysis.

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“…However, this invasive procedure is rather time-consuming and may not be available in all hospitals. Sag et al 23 . showed that CDT is an effective alternative in patients with failed ST, leading to improvement of clinical outcomes and echocardiographic parameters at a low complication rate.…”

Section: Catheter-based Therapies In High-risk Pulmonary Embolism Patmentioning

confidence: 99%

Rationale for catheter-based therapies in acute pulmonary embolism

Winter

Vlachojannis

Ruigrok

et al. 2019

European Heart Journal Supplements

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Pulmonary embolism (PE) is a common disease resulting in significant morbidity and mortality. High-risk features of PE are hypotension or shock, and early reperfusion is warranted to unload the strained right ventricle and improve clinical outcomes. Currently, systemic thrombolysis (ST) is the standard of care but is associated with bleeding complications. Catheter-based therapies (CDT) have emerged as a promising alternative having demonstrated to be equally effective while having a lower risk of bleeding. Several CDT are currently available, some combining mechanical properties with low-dose thrombolytics. Recent guidelines suggest that CDT may be considered in patients with high-risk PE who have high bleeding risk, after failed ST, or in patients with rapid haemodynamic deterioration as bail-out before ST can be effective, depending on local availability and expertise. In haemodynamically stable patients with right ventricular (RV) dysfunction (intermediate-risk PE), CDT may be considered if clinical deterioration occurs after starting anticoagulation and relative contraindications for ST due to bleeding risk exist. Decision on treatment modality should follow a risk-benefit analysis on a case by case base, weighing the risk of PE-related complications; i.e. haemodynamic deterioration vs. bleeding. As timely initiation of treatment is warranted to prevent early mortality, bleeding risk factors should be assessed at an early stage in all patients with acute PE and signs of RV dysfunction. To ensure optimal management of complex cases of PE and assess a potential CDT strategy, a multidisciplinary approach is recommended. A dedicated Pulmonary Embolism Response Team may optimize this process.

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Catheter-directed ultrasound-accelerated thrombolysis may be life-saving in patients with massive pulmonary embolism after failed systemic thrombolysis

Cited by 19 publications

References 18 publications

Percutaneous mechanical thrombectomy in patients with high-risk pulmonary embolism and contraindications for thrombolytic therapy

Percutaneous mechanical thrombectomy in patients with high-risk pulmonary embolism and contraindications for thrombolytic therapy

Ultrasound-Assisted Catheter-Directed Thrombolysis for Submassive Pulmonary Embolism

Rationale for catheter-based therapies in acute pulmonary embolism

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