Catheter-directed Thrombolysis for Severe Pulmonary Embolism in Pediatric Patients

Bavare, Aarti; Naik, Swati; Lin, Peter H.; Poi, Mun J.; Yee, Donald L.; Bronicki, Ronald A.; Philip, Joseph; Desai, Moreshwar S.

doi:10.1016/j.avsg.2014.03.016

Cited by 27 publications

(25 citation statements)

References 31 publications

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“…The EKOS system has been shown to be as effective as therapy with lytic agents alone, while reducing infusion times and the incidence of therapy‐related complications . The EKOS system has been used in children ; however, to our knowledge, the infant in our series is the smallest child to date in whom the EKOS system has been used. While this system holds promise for the treatment of thrombotic disease in children, the catheter system currently requires a 6 Fr introducer sheath and must be left indwelling for generally at least 24 hr.…”

Section: Discussionmentioning

confidence: 94%

Efficacy and safety of catheter‐based rheolytic and aspiration thrombectomy in children

Qureshi

Petit

Crystal

et al. 2016

Cathet Cardio Intervent

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Section: Discussionmentioning

confidence: 94%

Efficacy and safety of catheter‐based rheolytic and aspiration thrombectomy in children

Qureshi

Petit

Crystal

et al. 2016

Cathet Cardio Intervent

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“…Upon our review of the literature, we identified 15 patients with submassive PE from four retrospective cohort studies who had undergone CDT (including the NCH cohort; Supporting Information Table S2). CDT was well tolerated with only one patient developing a mild gastrointestinal bleed that was medically managed. Additionally, all 15 patients had normalization of right ventricular function on post‐intervention echocardiography.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Catheter‐directed thrombolysis for submassive pulmonary embolism in children: A case series

Belsky

Warren

Stanek

et al. 2019

Pediatric Blood & Cancer

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Incidence of venous thromboembolism, including pulmonary embolism (PE), continues to rise in children. Optimum management of submassive PE is unclear. The principal objective of this retrospective study was to investigate the radiological and clinical outcomes in children with submassive PE treated with catheter‐directed thrombolysis (CDT). Five patients underwent six episodes of CDT. No patient developed major/clinically relevant non‐major bleeding. Most patients had complete radiological thrombus resolution and no patient had evidence of chronic thromboembolic pulmonary hypertension. There is an urgent need for larger prospective cohort studies/randomized controlled trials to investigate the role of CDT in pediatric PE.

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“…28 In patients with submassive pulmonary embolism, EkoSonic Endovascular System catheter-directed thrombolysis is an approved treatment methodology for adult patients, but it is not performed widely in pediatric patients, so experience in this setting is limited. 29 The 2 classic trials that specify a dosing protocol and duration of treatment for ultrasound-assisted thrombolysis are the ULTIMA and the SEATTLE II trials. 16,17 These studies were based on adult populations and used the EkoSonic Endovascular System.…”

Section: Discussionmentioning

confidence: 99%

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

Kajy

Blank

Alraies

et al. 2019

TOJ

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Background: The clinical presentation of hereditary spherocytosis varies from no symptoms to severe hemolytic anemia requiring splenectomy. Splenectomy imposes the risk of hypercoagulability and acute pulmonary embolism. Catheter-directed thrombolysis is an established treatment for submassive pulmonary embolism in adults. However, the literature regarding its use in children is limited. Case Report: We present the case of a 12-year-old male with hereditary spherocytosis who was diagnosed with pulmonary embolism and successfully treated with catheter-directed thrombolysis. The patient was initially treated with 10.5 mg of recombinant tissue plasminogen activator (r-tPA) delivered over 8 hours. However, because of minimal clinical and hemodynamic improvement, a second course of thrombolytic was administered for an additional 24 hours (25 mg of r-tPA), and the treatment resulted in marked clinical and hemodynamic improvement. Clot resolution was confirmed via angiography. The patient was discharged on enoxaparin and with regular follow-up. One year later, the patient was asymptomatic on enoxaparin. Conclusion: This case demonstrates that catheter-based treatment of submassive pulmonary embolism restores hemodynamic stability and thus is an alternative to surgery or systemic thrombolysis, even in the pediatric setting. While catheter-directed thrombolysis is a safe and effective alternative to systemic thrombolysis, further research is needed to establish appropriate dosing and indications in the adolescent population.

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Catheter-directed Thrombolysis for Severe Pulmonary Embolism in Pediatric Patients

Cited by 27 publications

References 31 publications

Efficacy and safety of catheter‐based rheolytic and aspiration thrombectomy in children

Efficacy and safety of catheter‐based rheolytic and aspiration thrombectomy in children

Catheter‐directed thrombolysis for submassive pulmonary embolism in children: A case series

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

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