Use of Catheter-Directed Thrombolysis to Treat Acute Intermediate-Risk Pulmonary Embolism Associated With Baseline Pulmonary Hypertension

Abstract

Catheter directed thrombolysis (CDL) is increasingly utilized as therapy for acute intermediate-risk pulmonary embolism (PE). Acute PE can lead to mild pulmonary hypertension (PHTN) but the role for CDL in patients with moderate to severe PHTN is uncertain. We investigate the impact of CDL on lowering PA pressure in PE patients with baseline hemodynamics suggestive of underlying PHTN. METHODS: 70 consecutive patients referred for CDL with acute intermediate-risk PE at two academic centers were included in this study. CT scan confirmed PE in all cases and intermediate risk was defined as having RV enlargement and/or troponin elevation without need for vasopressors. CDL was performed using a perfusion catheter with or without ultrasound and infusing t-PA at 1 mg/hour. Baseline hemodynamics were recorded at right heart catheterization, and post treatment pressures were measured through the perfusion catheter.