Pulmonary Embolism Response to Fragmentation, Embolectomy, and Catheter Thrombolysis (PERFECT)

Midterm outcomes of catheter-directed interventions for the treatment of acute pulmonary embolism

“…8 In addition, several studies have questioned the clinical applicability of radiographic measures of thrombus burden as a prognostic indicator. [10][11][12] Our paradigm for management of acute PE treatment has similarly shifted from the traditional emphasis on measures such as Miller score to managing treatment based on physiologic measurements of cardiac function obtained from echocardiogram readings, as well as patient clinical condition. 6,12,13 In addition, we show that the hemodynamic benefits of CDIs are sustained through the one-year period, with survival and postoperative adverse event rates that correspond with those in the existing literature.…”

Systemic Thrombolysis Increases Hemorrhagic Stroke Risk Without Survival Benefit Compared to Catheter-Directed Intervention for the Treatment of Acute Pulmonary Embolism

“…This is supported by rough historical comparison of single-arm and comparative anticoagulation studies suggesting that CDI carries a decreased risk of bleeding relative to ST, although head-to-head prospective studies comparing ST and CDI have not been performed. Previous studies pooling randomized trials of thrombolytic therapy for acute PE have showed an intracranial bleeding risk 17,18,21 between 1.5-2.2%, compared to almost no reported intracranial hemorrhagic episodes in retrospective or prospective single-arm studies of catheter-directed intervention 11,12,14,19,20 . This is offset by a reportedly higher risk of major and moderate hemorrhagic complications, as demonstrated in our results and supported by recent findings in the SEATTLE II trial 19 , a single-arm study evaluating the effects of catheter-directed thrombolysis in 149 patients.…”

Catheter-directed interventions for pulmonary embolism

“…The Prospective, Single-arm, Multi-Center Trial of EkoSonic® Endovascular System and Activase for Treatment of Acute Pulmonary Embolism (SEATTLE II) trial, a single arm prospective study of 150 patients, showed a reduction in RVD and improvement in pulmonary hypertension in submassive and massive PE without any intracranial hemorrhage (10). The multicenter Pulmonary Embolism Response to Fragmentation, Embolectomy, and Catheter Thrombolysis (PERFECT) registry evaluated CDI for massive and submassive PE (11). Clinical success was regarded as stabilization of hemodynamics, improvement in pulmonary hypertension, and survival to discharge date.…”

“…Clinical success was regarded as stabilization of hemodynamics, improvement in pulmonary hypertension, and survival to discharge date. Clinical success rate was 86% for massive and 97% for submassive PE, with improvement in pulmonary hypertension and RV strain without major hemorrhagic complications (11). As a result of adaptation of a PERT, one study reported an increased number of patients appropriately treated with CDI with resultant reduced mortality compared to the national registry (48).…”