Ultrasound-Assisted Catheter-Directed Thrombolysis in High-Risk and Intermediate-High-Risk Pulmonary Embolism: Results From a Single-Center Cohort

Kaymaz, Ci̇hangi̇r; Öztürk, Selçuk; Akbal, Özgür Yaşar; Tanboğa, İbrahi̇m Hali̇l; Yılmaz, Fatih; Poci, Nertila; Turkday, Sevim; Hakgör, Aykun; Yıldız, Canan; Aktemur, Tuğba; Özdemir, Nihal; Konstantinides, Stavros

doi:10.1177/0003319716661446

Cited by 18 publications

(12 citation statements)

References 30 publications

(50 reference statements)

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“…A higher all-cause mortality was observed in our population compared to other studies [18, 19, 24, 25]. This could, similarly, reflect our study population of high-risk patients only, whose risk of death is almost ten times that of those with intermediate-risk PE [1, 4].…”

Section: Discussionsupporting

confidence: 74%

“…Several reasons can be identified for this higher incidence compared to ± 10% major bleeding in previous literature. Our study population involved patients with high-risk PE only, as opposed to 12–22% with high-risk PE in other studies [ 15 , 16 , 18 , 19 , 24 , 25 ]. Furthermore, our findings are based on real-world data and reflect how current guidelines are put into practice.…”

Section: Discussionmentioning

confidence: 99%

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Local Ultrasound-Facilitated Thrombolysis in High-Risk Pulmonary Embolism: First Dutch Experience

Winter

Hart

Heuvel

et al. 2019

Cardiovasc Intervent Radiol

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Purpose To provide insight into the current use and results of ultrasound-facilitated catheter-directed thrombolysis (USAT) in patients with high-risk pulmonary embolism (PE). Introduction Systemic thrombolysis is an effective treatment for hemodynamically unstable, high-risk PE, but is associated with bleeding complications. USAT is thought to reduce bleeding and is therefore advocated in patients with high-risk PE and contraindications for systemic thrombolysis. Methods We conducted a retrospective cohort study of all patients who underwent USAT for high-risk PE in the Netherlands from 2010 to 2017. Characteristics and outcomes were analyzed. Primary outcomes were major (including intracranial and fatal) bleeding and all-cause mortality after 1 month. Secondary outcomes were all-cause mortality and recurrent venous thromboembolism within 3 months. Results 33 patients underwent USAT for high-risk PE. Major bleeding occurred in 12 patients (36%, 95% CI 22–53), including 1 intracranial and 3 fatal bleeding. All-cause mortality after 1 month was 48% (16/33, 95% CI 31–66). All-cause mortality after 3 months was 50% (16/32, 95% CI 34–66), recurrent venous thromboembolism occurred in 1 patient (1/32, 3%, 95% CI 1–16). Conclusions This study was the first to describe characteristics and outcomes after USAT in a study population of patients with high-risk PE only, an understudied population. Although USAT is considered a relatively safe treatment option, our results illustrate that at least caution is needed in critically ill patients with high-risk PE. Further research in patients with high-risk PE is warranted to guide patient selection.

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Section: Discussionsupporting

confidence: 74%

Section: Discussionmentioning

confidence: 99%

Local Ultrasound-Facilitated Thrombolysis in High-Risk Pulmonary Embolism: First Dutch Experience

Winter

Hart

Heuvel

et al. 2019

Cardiovasc Intervent Radiol

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“…Experience with other CDT systems in sub-massive or massive PE has been based on off-label utilization in anecdotal case reports, small retrospective series comprising highly selected patient groups, and systematic reviews or meta-analyses of heterogeneous datasets (10)(11)(12)(13). Only one of these, an ultrasound-assisted thrombolysis technology, EkoSonic ® Endovascular System (Boston Scientific Corporation, USA), was tested in randomized clinical trials (7,8,14) and has been reported to facilitate thrombolysis with reduced lytic dosages, which leads to lowered bleeding risk in patients with PE at high and intermediate-high-risk (IHR) status (7,8,(14)(15)(16)(17).…”

Section: Introductionmentioning

confidence: 99%

A seven-year single-center experience on AngioJet rheolytic thrombectomy in patients with pulmonary embolism at high risk and intermediate-high risk

Akbal

Keskin

Tokgoz

et al. 2021

The Anatolian Journal of Cardiology

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Objective: AngioJet rheolytic thrombectomy (ART) has been used as a catheter-based treatment for acute pulmonary embolism (PE). In this study, based on our 7-year experience with ART in patients with PE, we evaluated the efficacy and safety outcomes of ART. Methods: Our study is based on retrospective evaluation of 56 patients with high-and intermediate-high-risk PE, with an average age of 62 years [interquartile range (IQR) 50-73 years] who underwent ART. Results: High and intermediate-high risks were noted in 21.4% and 78.6% of the patients, respectively. The ART duration was 304 (IQR: 246-468) seconds. Measures of obstruction, right to left ventricle diameter ratio, right to left atrial diameter ratio, and pulmonary arterial pressures were improved (p<0.001 for all). During the hospital stay, acute renal failure, major and minor bleeding, and mortality rates were 37.5%, 7.1%, 12.5%, and 8.9%, respectively. Aging related to post-procedural nephropathy while high-risk status was associated with in-hospital mortality (p=0.006) and long-term mortality. Conclusion: ART resulted in significant and clinically relevant improvements in the pulmonary arterial thrombotic burden, right ventricle strain, and hemodynamics in patients with PE at high and intermediate-high risk. Aging increased the risk of post-procedural nephropathy, whereas baseline high-risk status predicted in-hospital and long-term mortality.

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“…The results of EKOS in patients with highrisk and intermediate-high-risk PE were analyzed retrospectively in another study including Turkish patients. [26] The authors found that USAT achieved thrombus resolution and hemodynamic healing in both high-risk and intermediate-high-risk PE patients. The complications related to the procedure were acceptable.…”

Section: Discussionmentioning

confidence: 97%

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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Ultrasound-Assisted Catheter-Directed Thrombolysis in High-Risk and Intermediate-High-Risk Pulmonary Embolism: Results From a Single-Center Cohort

Cited by 18 publications

References 30 publications

Local Ultrasound-Facilitated Thrombolysis in High-Risk Pulmonary Embolism: First Dutch Experience

Local Ultrasound-Facilitated Thrombolysis in High-Risk Pulmonary Embolism: First Dutch Experience

A seven-year single-center experience on AngioJet rheolytic thrombectomy in patients with pulmonary embolism at high risk and intermediate-high risk

Analysis of pulmonary embolism patients treated with EkoSonicTM endovascular system

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