Catheter-directed Therapy for the Treatment of Massive Pulmonary Embolism: Systematic Review and Meta-analysis of Modern Techniques

Angiojet Rheolytic Thrombectomy in Massive Pulmonary Embolism: Locally Efficacious but Systemically Deleterious?

“…First, the results of our comprehensive systematic review and rigorous metaanalysis are by definition more valid than any review article that lacks evidence-based methods. Second, Kucher's review describes a very high clinical success rate among cases of modern CDT (89.2%, n ϭ 240) (2) in concordance with our study results (86.5%, n ϭ 594) (1). In our discussion, we acknowledge this and firmly conclude that the results from our metaanalysis support and extend the general conclusions of earlier review articles, which all describe a high clinical success rate for modern CDT (1).…”

“…This was shown in the earlier study by Bratby et al (1) we referenced in our study. They used an anthropomorphic phantom and simulated unilateral and bilateral procedures based on values from their study.…”

“…During our research, we noted from the literature that almost all patients referred for CDT were patients with massive (not submassive) PE, and we carefully excluded the few cases of submassive PE from our study (1). Over the years, because CDT has been regarded as an experimental treatment offered at select institutions, it has typically been reserved for PE patients in extremis when all conventional therapies have failed.…”

Endovascular Treatment for Acute Pulmonary Embolism in Neurological Patient

“…In a recently published metaanalysis, only 594 cases of acute massive PE have been treated with catheter directed therapy (CDT), with a success rate of about 86%. (2) A variety of endovascular techniques have been reported in the literature for patients with PE but there are no randomized controlled trials to compare the efficacy amongst them or with systemic thrombolysis, with or without anticoagulation. (3) Although the first patient was a candidate for systemic thrombolysis but refractory arterial hypotension and need for CPR led to the selection of catheter directed therapy as the modality of choice.…”

Catheter-directed interventions for pulmonary embolism

“…The most widely used method is thromboembolus fragmentation by manual rotation of a pigtail catheter in the main, right, or left PA (23). Using the rotating pigtail catheter method, one group achieved an average of 33% recanalization through the thrombosed vessel, with concomitant reduction in PA pressure and shock index (24).…”