Local Thrombolysis in High-Risk Pulmonary Embolism—13 Years Single-Center Experience

Abstract

To evaluate the prognosis after local thrombolysis compared to systemic thrombolysis in high-risk pulmonary embolism. Observational study during 13 years which included 37 patients with high-risk pulmonary embolism treated with local thrombolysis and 36 patients with systemic thrombolysis (streptokinase, 250 000 UI/30 minutes followed by 100 000 UI/h). Cardiogenic shock has totally remitted in the group with local thrombolysis ( P = .002). The decrease in pressure gradient between right ventricle and right atrium was comparable in both groups in the acute period (the results being influenced by the higher in-hospital mortality after systemic thrombolysis), but significantly better in the next 24 months follow-up after in situ thrombolysis. Major and minor bleeding did not have significant differences. In hospital, mortality was significantly lower in the group with local thrombolysis ( P = .003), but for the next 24 months follow-up, the survival was comparable in both groups. Local thrombolysis, during the hospitalization, was associated with lower mortality rate comparing with systemic thrombolysis. In the next 24 months follow-up, the evolution of residual pulmonary hypertension was significantly better after in situ thrombolysis.

Case Report: Thrombus aspiration and in situ thrombolysis via a Guidezilla guide extension catheter in a patient with high-risk pulmonary embolism

“…The standard CDT involves advancing the dedicated catheters into the culprit pulmonary artery with thrombus distribution for restoration of pulmonary blood flow by delivering thrombolytics ( 6 ). Multiple studies have demonstrated the advantage of immediate thrombus removal through percutaneous catheter-directed thrombectomy and aspiration by providing strong evidence of excellent safety, which may be credited to locally administered low-dose thrombolytics ( 7 , 8 ). The FLASH trial evaluated the effectiveness of percutaneous catheter-directed thrombectomy and aspiration for the treatment of intermediate to high-risk PE and showed it has a tendency toward superiority in immediate hemodynamic improvements and cardiac function recovery ( 9 ).…”

Percutaneous thrombectomy in patients with intermediate- and high-risk pulmonary embolism and contraindications to thrombolytics: a systematic review and meta-analysis

“…Fasullo et al compared hemodynamic effects of systemic thrombolysis against anticoagulation alone, with a finding that systemic thrombolysis was superior in RV/LV ratio improvement (1.4 ± 0.05➝1.12 ± 0.04) against anticoagulation alone in intermediate-risk patients (1.42 ± 0.04➝1.25 ± 0.04) [ 35 ]. Macovei et al reported improvement in sPAP between local (decrease from 51 to 15 mmHg and systemic thrombolysis groups in high-risk patients (decrease from 70 to 37 mmHg) [ 36 ]. Although our findings suggest a less dramatic decrease in sPAP with non-fibrinolytic based therapies, there still remained a statistically significant drop in sPAP.…”