Catheter-directed interventions for acute pulmonary embolism

Abstract

Acute pulmonary embolism (PE) is a leading cause of cardiovascular mortality. Systemic anticoagulation is the standard of care, and treatment can be escalated in the setting of massive or submassive PE, given the high mortality risk. A secondary consideration for intervention is the prevention of late-onset chronic thromboembolic pulmonary hypertension. Treatment options include systemic thrombolysis, catheter-directed interventions, and surgical thromboembolectomy. Whereas systemic thrombolysis seems to be beneficial in the setting of massive PE, it appears to be associated with a higher rate of major complications compared with catheter-directed thrombolysis as shown in recent randomized trials for submassive PE. The hemodynamic and clinical outcomes continue to be defined to determine the indications for and benefits of intervention. The current review summarizes contemporary evidence on the role and outcomes of catheter-directed therapies in the treatment of acute massive and submassive PE.

Catheter-Directed Interventions for Acute Pulmonary Embolism

“…Th e paucity of prospective data regarding catheter-directed interventions for the treatment of acute massive or submassive pulmonary embolism (PE) is well recognized, 1 and Kuo and colleagues 2 are to be commended for presenting the fi rst prospective registry of such patients, to our knowledge, in this issue of CHEST (see page 667). Th eir use of a composite clinical success outcome is important as the combination of hemodynamic stabilization, echocardiographic improvement, and survival increases the face validity of this more patient-centric outcome compared with radiographic improvement alone.…”

Treatment of a Child With Submassive Pulmonary Embolism Associated With Hereditary Spherocytosis Using Ultrasound-Assisted Catheter-Directed Thrombolysis

“…11 The most widely suggested systemic thrombolysis regimen for massive pulmonary embolism in adults is 100 mg of alteplase infused over 2 hours. 12 The optimal dose of alteplase for systemic thrombolysis in children is not well established, and dosing is based on extrapolation from case series and adult treatment protocols. Because of the uncertainty of benefit vs the risk of massive and life-threatening bleeding, systemic thrombolysis for submassive pulmonary embolism is not indicated (class IIB/level of evidence C by most guidelines).…”

Surgical pulmonary embolectomy and catheter-directed thrombolysis for treatment of submassive pulmonary embolism

“…Acute pulmonary embolism (PE) is a major cause of morbidity and mortality, accounting for more than 200 000 annual hospitalizations in the United States, and 5‐10% of in‐hospital deaths in the developed world . The American Heart Association (AHA) classifies PE into three categories: massive, submassive, and low‐risk PE.…”