Advanced Therapies for Acute Pulmonary Embolism: A Focus on Catheter-Based Therapies and Future Directions

Burton, John; Madhavan, Mahesh V.; Finn, Matthew; Ingrassia, Joseph; Bikdeli, Behnood; Nouri, Shayan Nabavi; Brailovsky, Yevgeniy; Rosenzweig, Erika B.; Takeda, Koji; Kirtane, Ajay J.; Sethi, Sanjum S.

doi:10.1080/24748706.2020.1853860

Cited by 9 publications

(6 citation statements)

References 110 publications

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“… 16 Observational studies demonstrate improved surrogate end points among patients with intermediate- and high-risk PE. 17 As our patient with intermediate- to high-risk PE had persistent symptoms despite systemic anticoagulation, catheter-directed thrombolysis was selected as the next management step, leading to a significant subjective improvement. With several randomized control trials underway, we hope to see appropriate use criteria better defined for interventional therapies in acute PE.…”

Section: Discussionmentioning

confidence: 99%

Saddle Pulmonary Embolism Detected by Transthoracic Echocardiography in a Patient With Suspected Myocardial Infarction

Yuriditsky,

Horowitz,

Taslakian

et al. 2024

CASE

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Section: Discussionmentioning

confidence: 99%

Saddle Pulmonary Embolism Detected by Transthoracic Echocardiography in a Patient With Suspected Myocardial Infarction

Yuriditsky,

Horowitz,

Taslakian

et al. 2024

CASE

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“…Furthermore, the reduced risk of bleeding associated with USCDT has significant clinical implications, showing that USCDT could be a preferable option for patients at higher bleeding risk, such as those with a history of bleeding disorders, recent surgery, or other contraindications to aggressive anticoagulation therapy [18,[24][25][26]. This finding is relevant in the context of intermediate to high-risk APE, where effective thrombolysis can significantly impact the patient's outcomes, including reducing chronic pulmonary hypertension risk and improving functional status.…”

Section: Discussionmentioning

confidence: 99%

Ultrasound-Facilitated, Catheter-Directed Thrombolysis for Acute Pulmonary Embolism

Elheet,

Elhadidy,

Farrag

et al. 2024

Cureus

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Background: Acute pulmonary embolism (APE) poses a significant risk to patient health, with treatment options varying in efficacy and safety. Ultrasound-facilitated catheter-directed thrombolysis (USCDT) has emerged as a potential alternative to conventional catheter-directed thrombolysis (CDT) for patients with intermediate to high-risk APE. This study aimed to compare the efficacy and safety of USCDT versus conventional CDT in patients with intermediate to high-risk APE. Methods: This observational retrospective study was conducted at the Armed Forces Hospital, Al-Hada, Taif, the Kingdom of Saudi Arabia (KSA), on 135 patients diagnosed with APE and treated with either USCDT or CDT (58 underwent CDT, while 77 underwent USCDT). The primary efficacy outcome was the change in the right ventricle to the left ventricle (RV/LV) diameter ratio. Secondary outcomes included changes in pulmonary artery systolic pressure and the Miller angiographic obstruction index score. Safety outcomes focused on major bleeding events. Results: Both USCDT and CDT significantly reduced RV/LV diameter ratio (from 1.35 ± 0.14 to 1.05 ± 0.17, P < 0.001) and systolic pulmonary artery pressure (SPAP) (from 55 ± 7 mmHg to 38 ± 7 mmHg, P < 0.001) at 48- and 12-hours post-procedure, respectively, with no significant differences between treatments. However, USCDT was associated with a significantly lower rate of major bleeding events compared to CDT (0% vs. 3.4%, P = 0.008). Multivariate logistic regression analysis revealed that USCDT was associated with a 71.9% risk reduction of bleeding (OR = 0.281, 95% CI = 0.126 - 0.627, P = 0.002). Conclusions: USCDT is a safe and effective alternative to CDT for the treatment of intermediate to high-risk APE, as it significantly reduces the risk of major bleeding.

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“…Also, the Polish PERT Initiative has published an expert opinion on the use of CDTx in high-risk PE patients [34]. The introduction of PERTs, along with the publication of the ESC consensus statement, is an ideal moment to implement new devices, develop standardized protocols for CDL and CDT, and establish directions for future research [35][36][37].…”

Section: Discussionmentioning

confidence: 99%

Treatment of high- and intermediate-high-risk pulmonary embolism by the Pulmonary Embolism Response Team: Focus on catheter-directed therapies

Pietrasik

Kurzyna

Szwed³

et al. 2024

Cardiol J.

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Background Multidisciplinary Pulmonary Embolism Response Teams (PERTs) were established to individualize the treatment of high-risk (HR) and intermediate-high-risk (IHR) pulmonary embolism (PE) patients, which pose a challenge in clinical practice. Methods We retrospectively collected the data of all HR and IHR acute PE patients consulted by PERT CELZAT between September 2017 and October 2022. The patient population was divided into four different treatment methods: anticoagulation alone (AC), systemic thrombolysis (ST), surgical embolectomy (SE), and catheter-directed therapies (CDTx). Baseline clinical characteristics, risk stratification, PE severity parameters, and treatment outcomes were compared between the four groups. Results Of the 110 patients with HR and IHR PE, 67 (61%) patients were treated with AC only, 11 (10%) with ST, 15 (14%) underwent SE, and 17 (15%) were treated with CTDx. The most common treatment option in the HR group was reperfusion therapy, used in 20/24 (83%) cases, including ST in 7 (29%) patients, SE in 5 (21%) patients, and CTDx in 8 (33%) patients. In contrast, IHR patients were treated with AC alone in 63/86 (73%) cases. The in-hospital mortality rate was 9/24 (37.5%) in the HR group and 4/86 (4.7%) in the IHR group. Conclusions The number of advanced procedures aimed at reperfusion was substantially higher in the HR group than in the IHR PE group. Despite the common use of advanced reperfusion techniques in the HR group, patient mortality remained high. There is a need further to optimize the treatment of patients with HR PE to improve outcomes.

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Advanced Therapies for Acute Pulmonary Embolism: A Focus on Catheter-Based Therapies and Future Directions

Cited by 9 publications

References 110 publications

Saddle Pulmonary Embolism Detected by Transthoracic Echocardiography in a Patient With Suspected Myocardial Infarction

Saddle Pulmonary Embolism Detected by Transthoracic Echocardiography in a Patient With Suspected Myocardial Infarction

Ultrasound-Facilitated, Catheter-Directed Thrombolysis for Acute Pulmonary Embolism

Treatment of high- and intermediate-high-risk pulmonary embolism by the Pulmonary Embolism Response Team: Focus on catheter-directed therapies

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