Interventional therapies for pulmonary embolism

Abstract

Pulmonary embolism (PE) is the leading cause of in-hospital death and the third most frequent cause of cardiovascular death. The clinical presentation of PE is variable, and choosing the appropriate treatment for individual patients can be challenging. Traditionally, treatment of PE has involved a choice of anticoagulation, thrombolysis or surgery; however, a range of percutaneous interventional technologies have been developed that are under investigation in patients with intermediate–high-risk or high-risk PE. These interventional technologies include catheter-directed thrombolysis (with or without ultrasound assistance), aspiration thrombectomy and combinations of the aforementioned principles. These interventional treatment options might lead to a more rapid improvement in right ventricular function and pulmonary and/or systemic haemodynamics in particular patients. However, evidence from randomized controlled trials on the safety and efficacy of these interventions compared with conservative therapies is lacking. In this Review, we discuss the underlying pathophysiology of PE, provide assistance with decision-making on patient selection and critically appraise the available clinical evidence on interventional, catheter-based approaches for PE treatment. Finally, we discuss future perspectives and unmet needs.

Ultrasound‐assisted endovascular thrombolysis versus large‐bore thrombectomy in acute intermediate‐high risk pulmonary embolism: The propensity‐matched EKNARI cohort study

“…1,2,5 USAT and LBT are both approved by the US Food and Drug Administration (FDA) and are available in Europe. 2 While USAT was investigated in randomized, controlled trials versus anticoagulation and CDT, 5,7 randomized controlled trials investigating mechanical thrombectomy versus USAT are currently ongoing. 2 The ongoing HI-PEITHO trial is randomly assigning ≥406 patients with intermediate-risk PE to either USAT (with the EKOS system) or anticoagulation alone.…”

“…2 While USAT was investigated in randomized, controlled trials versus anticoagulation and CDT, 5,7 randomized controlled trials investigating mechanical thrombectomy versus USAT are currently ongoing. 2 The ongoing HI-PEITHO trial is randomly assigning ≥406 patients with intermediate-risk PE to either USAT (with the EKOS system) or anticoagulation alone. PE-related mortality, PE recurrence and hemodynamic decompensation (all after 7 days) will be assessed as primary end points.…”

“…Catheter-directed therapy (CDT) can be considered in patients with intermediate-high or high-risk pulmonary embolism (PE) and those with contraindications to systemic thrombolysis. 1,2 Several systems have been developed over the last years and are available for clinical use. Ultrasound-accelerated endovascular thrombolysis (USAT) aims to reduce bleeding risk by using ultrasound energy and low-dose thrombolysis injected directly into the pulmonary arteries.…”

Pulmonary Embolism: An Update Based on the Revised AWMF-S2k Guideline

“…Endovascular mechanical procedures for thrombus fragmentation or thrombus removal use rotational, aspiration, hydrodynamic, or suction thrombectomy. 41,42 The aim is to improve RV function by reducing the size of the thrombus and the thrombus load. In some cases, mechanical thrombectomy is also used in combination with thrombolysis, in which case thrombolytics are usually administered in low doses, sometimes ultrasound assisted.…”

Superhydrophilic and Antifriction Thin Hydrogel Formed under Mild Conditions for Medical Bare Metal Guide Wires

“…Interventional therapy has been considered as a very effective method of diagnosing and treating local lesions located in the cardiovascular system, nervous system, respiratory system, etc. − The success of intravascular interventional therapy depends on complex and delicate medical guide wires, which are roughly composed of the inner metal core wires from end to end, the spring coil sheaths using various metal materials at the head end, and the probable polymer coatings on the whole surface, with small overall diameters of <1 mm. The market demand for guide wires is significantly increasing all around the world.…”