Catheter-Directed Therapy in Acute Pulmonary Embolism with Right Ventricular Dysfunction: A Promising Modality to Provide Early Hemodynamic Recovery

Abstract

BackgroundCatheter-directed therapy (CDT) for pulmonary embolism (PE) is considered as an alternative to systemic thrombolysis (ST) in patients with hemodynamically unstable acute PE who are considered at high bleeding risk for ST. We aimed to evaluate the efficacy and safety of CDT in the management of acute PE with right ventricular dysfunction (RVD). The primary outcomes were mortality, clinical success, and complications. Secondary outcomes were change in hemodynamic parameters in the first 24 hours following the procedure.Material/MethodsMedical records of consecutive patients diagnosed as having acute massive or submassive PE with accompanying RVD treated by immediate CDT at our institution from January 2007 to January 2014 were reviewed. Patient characteristics, mortality, achievement of clinical success, and minor and major bleeding complications were analyzed in the overall study group, as well as massive vs. submassive PE subgroups. Change in hemodynamic parameters in the second, eighth, and 24th hours after the CDT procedure were also analyzed.ResultsThe study included 15 consecutive patients (M/F=10/5) with a mean age of 54.2±16.6 years who underwent immediate CDT. Nine of the patients had submassive PE, and 6 had massive PE. In-hospital mortality rate was 13.3% (95% CI, 0.04–0.38). One major, but not life-threatening, bleeding episode was evident in the whole group. Hemodynamic parameters were stabilized and clinical success was achieved in 14/15 (93.3%; 95% CI, 70.2–98.8) of the patients in the first 24 hours. Notably, the hemodynamic recovery was significantly evident in the first 8 hours after the procedure.ConclusionsCDT is a promising treatment option for patients with acute PE with RVD with no fatal bleeding complication. In experienced centers, CDT should be considered as a first-line treatment for patients with acute PE and RVD and contraindications for ST, with the advantage of providing early hemodynamic recovery.

Intravascular forward-looking ultrasound transducers for microbubble-mediated sonothrombolysis

“…The catheter size for PE treatments is about 6 F to 11 F (i.e. 2 to 3.7 mm in diameter) 27 , 28 , so the custom catheters described herein composed of a miniaturized forward-looking transducer (lateral dimension <1.5 mm) and a microbubble injection tube (outer diameter of 1.1 mm), were developed as an 8F-prototype catheter (diameter of 2.7 mm). With this catheter device, sub-megahertz frequency ultrasound waves are excited to yield stable and inertial cavitation of locally-injected microbubbles near a target blood clot (Fig.…”

The Challenge of Intermediate-Risk Pulmonary Embolism

“…Multiple retrospective studies have provided evidence supporting superior outcomes with catheter-directed interventions compared with systemic tPA. 12,30,50,51 Catheter-directed thrombolysis (CDT)…”

Long-term prognostic analysis of early interventional therapy for lower extremity deep venous thrombosis

“…Previous findings have shown that interventional therapy has many advantages, such as causing small trauma, is safe and reliable, and is comparable and possibly superior to the effect of medication alone or the combined effect of medicine and surgery (6,7). Due to different sample sizes and follow-up times, the effects of interventional therapy were different (8,9). Whether early intervention of thrombolysis is an effective first-line treatment for LDVT is not yet known.…”