The Role of EkoSonic Endovascular System or EKOS® in Pulmonary Embolism

Abstract

Pulmonary embolism has become a cause of great concern to health care professionals. Despite strides in research and availability of sensitive diagnostic tests, the mortality and morbidity related to this entity continues to cause tremendous economic burden. Patients present with an array of symptoms ranging from mild dyspnea to hemodynamic instability and even death. Prompt recognition of symptoms along with early risk stratification can be lifesaving. Management focuses on achieving hemodynamic stability and reducing clot burden. Approved treatment modalities include anticoagulation, systemic or catheter directed thrombolytic therapy and surgical embolectomy. In this article we will review catheter-directed thrombolytic therapy, specifically the EKOS® or the EkoSonic endovascular system. EKOS® uses ultrasoundfacilitated catheter-directed thrombolysis. The rationale behind this therapy is using shorter infusion times and lower dosage of the thrombolytic therapy, thereby reducing the complications associated with their use.

Ultrasound Accelerated Catheter Directed Thrombolytic Therapy in a 15-Year-old Pulmonary Embolism Patient with CLOVES Syndrome

“…One of the most important advantages of this approach, as seen in this case, is the avoidance of potential complications of systemic anticoagulation therapies. 13 This is especially beneficial when managing post-operative patients where systemic therapy may be contraindicated. However, although it has been found that catheter-directed therapy had less in-hospital mortality than systemic thrombolysis in treatment PE, the evidence for pediatric population is lacking.…”

A Case of Failure of EkoSonic™ Endovascular System in the Treatment of Submassive Pulmonary Embolism

“…The evidence for using systemic thrombolysis with half-dose tPA for SPE was established by the Moderate Pulmonary Embolism Treated With Thrombolysis (MOPETT) trial, which showed that half-dose tPA plus systemic AC decreased pulmonary hypertension incidence, PA pressures, and hospital stay [ 5 ]. Even the PERT Consortium guidelines suggest using low-dose tPA for SPE cases with evidence of clinical deterioration based on vital signs, the severity of RV dysfunction, tissue perfusion, and gas exchange in the absence of absolute contraindications to thrombolysis.…”

Sudden cardiac death: epidemiology, pathogenesis and management

“…Similarly, patients with severe aortic stenosis require relief of outflow tract obstruction with some form procedure including balloon aortic valvotomy, transcatheter aortic valve replacement depending upon their ability to tolerate these procedures. Additonally, survivors of acute pumonary embolism need definitive treatment using procedure like transcatheter guided thrombolysis (EKOS) or pulmonary thromboendarterectomy utilizing cardiopulmonary bypass support [102].…”