Ultrasound-assisted thrombolysis for acute pulmonary embolism: a systematic review

Abstract

Pulmonary embolism remains a common and potentially life-threatening disease. For patients with intermediate- and high-risk pulmonary embolism, catheter-based revascularization therapy has emerged as potential alternative to systemic thrombolysis or surgical embolectomy. Ultrasound-assisted catheter-directed thrombolysis is a contemporary catheter-based technique and is the focus of the present review. Ultrasound-assisted catheter-directed thrombolysis is more effective in reversing right ventricular dysfunction and dilatation in comparison with anticoagulation alone in patients at intermediate risk. However, a direct comparison of ultrasound-assisted thrombolysis with systemic thrombolysis or surgical thrombectomy is not available. Ultrasound-assisted thrombolysis with initial intrapulmonary thrombolytic bolus may also be effective in high-risk patients, but evidence from randomized trials is not available. This review summarizes current data on ultrasound-assisted thrombolysis for acute pulmonary embolism.

Ultrasound-Assisted Versus Conventional Catheter-Directed Thrombolysis for Acute Iliofemoral Deep Vein Thrombosis

“…10 A further development is ultrasound-assisted catheter-directed thrombolysis (USAT), combining CDT with a catheter system that uses high-frequency, low-power ultrasound. 11 According to in vitro studies, ultrasound causes reversible disaggregation of uncrosslinked fibrin fibers, and ultrasound pressure waves increase thrombus penetration of thrombolytic drugs by acoustic streaming. [12][13][14] It remains controversial whether USAT is superior to conventional CDT.…”

Treatment of pulmonary embolism with ultrasound-accelerated thrombolysis after coronary revascularization

“…[2] In high-risk patients who are ineligible to receive thrombolytic therapy or whose critical status does not allow sufficient time for systemic therapy to be effective, the use of interventional catheterization techniques which are safer than systemic thrombolysis should be considered. [5] In a case report, Ozker et al [6] reported catheter thrombectomy and aspiration of massive PE in a patient with recent CABG procedure with rapid recovery of clinical status. Ultrasoundassisted catheter directed thrombolysis combines catheter-directed thrombolysis with a specific catheter which uses high-frequency, low-power ultrasound, offering rapid revascularization without increased complication rates.…”

“…Ultrasoundassisted catheter directed thrombolysis combines catheter-directed thrombolysis with a specific catheter which uses high-frequency, low-power ultrasound, offering rapid revascularization without increased complication rates. [5] There are few publications focusing on the utilization of the USAT in high-risk PE patients. Kennedy et al [7] reported 98% complete or near complete clearance of the thrombi among 60 patients with acute PE who were treated with anticoagulation and USAT.…”

“…In addition, a recent systematic review including seven studies on the USAT treatment among 197 PE patients demonstrated a rate of major bleeding complications of 3.6% without any fatal or intracranial bleedings. [5] The authors concluded that, although catheter-based therapies were accepted as alternative revascularization strategies to systemic thrombolysis for intermediate-risk patients and were still unproven for high-risk patients, they might be indicated in selected cases when bleeding risk was high.…”

Pulmonary embolism: clinical guidelines of European Society of Cardiology (2014)*

“…Если антикоагулянтная монотерапия гепарином в первые 24-48 ч недостаточно влияет на размеры ПЖ и его функцию [304], то степень раннего восста новления ПЖ после катетерного тромболизиса низ кими дозами препаратов сравнима с эффектом си стемного тромболизиса стандартными дозами [303,335]. В рандомизированном контролируемом клини ческом исследовании (n = 59) у больных с умеренным риском при катетерном тромболизисе (введение 10 мг tPA в течение 15 ч в пораженное легкое) с ультразву ковым контролем по сравнению с монотерапией ге парином значительно уменьшалось соотношение подклапанных размеров ПЖ / ЛЖ через 24 ч от нача ла лечения без увеличения риска кровотечений [336].…”