Ultrasound-Accelerated Catheter-Directed Thrombolysis for Acute Submassive Pulmonary Embolism

Bagla, Sandeep; Smirniotopoulos, John; Breda, Arina van; Sheridan, Michael J.; Sterling, Keith M.

doi:10.1016/j.jvir.2014.12.017

Cited by 57 publications

(39 citation statements)

References 33 publications

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“…The literature shows that LOS following PE ranges from 5 to 11 days. [13][14][15][16][17] If a PERT participates in the care of a patient for the duration of the hospitalization (which was not true for the WCMC PERT), then it can give discharge recommendations and potentially impact LOS. However, a PERT may also impact LOS based on how it manages severe PE.…”

Section: Discussionmentioning

confidence: 99%

A pulmonary embolism response team’s initial 20 month experience treating 87 patients with submassive and massive pulmonary embolism

et al. 2017

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Pulmonary Embolism Response Teams (PERTs) have emerged to provide rapid multidisciplinary assessment and treatment of PE patients. However, descriptive institutional experience and preliminary outcomes data from such teams are sparse. PERT activations were identified through a retrospective review. Only confirmed submassive or massive PEs were included in the data analysis. In addition to baseline variables, the therapeutic intervention, length of stay (LOS), in-hospital mortality, and bleeding rate/severity were recorded. A total of 124 PERT activations occurred over 20 months: 43 in the first 10 months and 81 in the next 10. A total of 87 submassive (90.8%) and massive (9.2%) PE patients were included. The median age was 65 (51-75 IQR) years. Catheter-directed thrombolysis (CDT) was administered to 25 patients, systemic thrombolysis (ST) to six, and anticoagulation alone (AC) to 54. The median ICU stay and overall LOS were 6 (3-10 IQR) and 7 (4-14 IQR) days, respectively, with no association with any variables except a brain natriuretic peptide (BNP) >100 pg/mL ( p=0.008 ICU LOS; p=0.047 overall LOS). Twelve patients (13.7%) died in the hospital, nine of whom had metastatic or brain cancer, with a median overall LOS of 13 (11-17 IQR) days. There were five major bleeds: one in the CDT group, one in the ST group, and three in the AC group. Overall, (1) PERT activations increased after the first 10 months; (2) BNP >100 pg/mL was associated with a longer LOS; (3) rates of mortality and bleeding did not correlate with treatment; and (4) the majority of in-hospital deaths occurred in patients with advanced cancer.

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Section: Discussionmentioning

confidence: 99%

A pulmonary embolism response team’s initial 20 month experience treating 87 patients with submassive and massive pulmonary embolism

et al. 2017

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“…Similarly, in a retrospective study of 45 patients with intermediate-high-risk PE, a decrease in PAP and improvement in RVD were statistically significant in 30-day follow-up after USAT. [18] Complications revealed minor bleeding in four patients and major bleeding in two patients at the sites of entry. [18] In these two studies, PAP reduction and correction of RVD were similar to the results of our study.…”

Section: Discussionmentioning

confidence: 95%

Analysis of pulmonary embolism patients treated with EkoSonicTM endovascular system

Şaylan

Çalışkan

Canoğlu

et al. 2020

Turk Gogus Kalp Dama

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Bu çalışmada, orta-yüksek riskli pulmoner emboli tanısıyla hastaneye yatırılan hastalardaki EkoSonic™ endovasküler sistem uygulamalarının etkinliği ve güvenliliği değerlendirildi. Ça lış ma pla nı: Ocak 2018-Mart 2019 tarihleri arasında, pulmoner emboli nedeniyle EkoSonic™ endovasküler sistemi kullanılarak ultrasonografi ile hızlandırılmış tromboliz yapılan toplam 15 hasta (7 erkek, 8 kadın; ort. yaş 64.7±17.8 yıl; dağılım, 35-90 yıl) retrospektif olarak incelendi. Pulmoner emboli tanısı, pulmoner bilgisayarlı tomografi anjiyografi ile konuldu. Hastaların tümü sağ ventrikül disfonksiyonu açısından ekokardiyografi ile değerlendirildi ve serum troponin I ve beyin natriüretik peptid düzeyleri kaydedildi. Bul gu lar: Hastaların işlem öncesinde ve sonrasında ortalama arteriyel kan gazı oksijen satürasyon değerleri sırasıyla %86.3±3.5 ve %94.2±2.5 olup, istatistiksel olarak anlamlı fark saptandı (p= 0.001). İşlem öncesinde ve sonrasında ortalama parsiyel oksijen basıncı değerleri 73.3±7.7 mmHg ve 90.7±5.0 mmHg olup, istatistiksel olarak anlamlı fark saptandı (p= 0.001). İşlem öncesinde ve sonrasında ortalama sağ ventrikül çapı açısından da istatistiksel olarak anlamlı bir fark vardı (p= 0.001). İşlem öncesinde ve sonrasında ortalama pulmoner arter basıncı sırasıyla 44±7.1 mmHg ve 36.3±4.5 mmHg olup, istatistiksel olarak anlamlı fark saptandı (p= 0.001). Hastaların %93.7'sinde işlem sonrasında komplikasyon gözlenmedi. So nuç: EkoSonic™ endovasküler system orta-yüksek riskli pulmoner emboli hastalarında kanama riskinde bir artışa neden olmaksızın sağ ventrikül disfonksiyonunu iyileştirdi; pulmoner arter basıncını azalttı ve oksijenasyonu düzeltti. Anah tarsöz cük ler: EkoSonic™ endovasküler sistem, pulmoner emboli, ultrasonografi ile hızlandırılmış tromboliz.

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“…8,21 In addition to hemorrhage, procedure-related complications include rethrombosis, vascular dissection, or even rupture. 22 Ultrasound-accelerated thrombolysis is emerging as a promising tool in many vascular beds, including in peripheral arterial, 23 venous, 24 portal, 25 pulmonary, 25,26 and even in intracerebral vasculature. 27 High-frequency ultrasound waves synergistically enhance the fibrinolytic effects of the thrombolytic due to direct-mechanical acoustic streaming, improving clot permeability via creation of micropores and thus potentially reducing tPA doses and infusion rates.…”

Section: Treatment Of Hepatic Artery Thrombosismentioning

confidence: 99%

Untitled

Pereira

Salsamendi²,

Dalal

et al. 2016

Exp Clin Transplant

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Objectives: Hepatic artery thrombosis remains a major complication after orthoptic liver transplant. Treatment of hepatic artery thrombosis is complex and requires a multidisciplinary approach. Retransplant is the procedure of choice. In nonsurgical candidates, endovascular options are evolving. Materials and Methods: Based on our experience at a busy transplant center, we discuss 4 representative cases to explain the potential role of endovascular treatment beyond just attempts at recanalization. From our experience, as well as a review of the literature, we propose a clinical practice algorithm for optimal treatment of hepatic artery thrombosis after orthoptic liver transplant. Results: The primary traditional endovascular interventional options remain thrombectomy, balloon angioplasty, and use of stents with the aim of revascularization. However, these methods have not proven to be effective. Ultrasonography-assisted thrombolysis, which has thus far been relatively less described in the hepatic vasculature, has the potential of producing the same angiographic results but at lower doses of the thrombolytic agent, thus decreasing the potential for hemorrhagic complications. The adjunctive use of splenic artery embolization and prompt treatment of biliary complications are in our opinion useful in "buying time" to allow adequate development of collateral "neovascularization of the liver," thus preventing further ischemia. Conclusions: Although surgical retransplant still remains the standard treatment for hepatic artery thrombosis, organ shortages and high mortality still exist. Endovascular techniques are rapidly evolving, but these techniques are dependent on expertise available and, even in the best hands, have not proven to be effective at reversing hepatic artery thrombosis. The use of a multimodality endovascular approach could salvage the liver allografts, thereby preventing retransplant or facilitating transplant at a more elective setting.

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Ultrasound-Accelerated Catheter-Directed Thrombolysis for Acute Submassive Pulmonary Embolism

Cited by 57 publications

References 33 publications

A pulmonary embolism response team’s initial 20 month experience treating 87 patients with submassive and massive pulmonary embolism

A pulmonary embolism response team’s initial 20 month experience treating 87 patients with submassive and massive pulmonary embolism

Analysis of pulmonary embolism patients treated with EkoSonicTM endovascular system

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