Comparison of Ultrasound-Accelerated versus Pigtail Catheter–Directed Thrombolysis for the Treatment of Acute Massive and Submassive Pulmonary Embolism

Graif, Assaf; Grilli, C.; Kimbiris, G.; Agriantonis, D.J.; Chohan, Omar; Fedele, Charles R.; Gakhal, Mandip; Vance, Ansar Z.; Leung, Daniel A.

doi:10.1016/j.jvir.2017.07.004

Cited by 34 publications

(23 citation statements)

References 26 publications

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“…Prospective trials investigating catheter directed thrombolysis (CDT) of submassive pulmonary embolism (PE) demonstrated reduction of pulmonary artery pressure (PAP) [1] and right heart strain [2, 3] in CDT treatment arms. These results are corroborated by findings from the prospective multicenter Pulmonary Embolism Response to Fragmentation, Embolectomy, and Catheter Thrombolysis (PERFECT) registry [4] and retrospective studies [5–12]. However, thrombolytic dose and duration were limited to 4–24 mg tissue-plasminogen activator (t-PA) over 2–24 h in the prospective trials [1–3]; patients in PERFECT received a mean t-PA dose of 28±11 mg over 23.2±8.1 h using ultrasound assisted thrombolysis (USAT) or 20.8±11.5 h with standard CDT [4].…”

Section: Introductionsupporting

confidence: 67%

Tissue plasminogen activator dose and pulmonary artery pressure reduction in catheter directed thrombolysis of submassive pulmonary embolism

et al. 2019

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PurposeThe purpose of this study is to assess the incremental effect of tissue plasminogen activator (t-PA) dose on pulmonary artery pressure (PAP) and bleeding during catheter directed thrombolysis (CDT) of submassive pulmonary embolism (PE).Materials and methodsRecords of 46 consecutive patients (25 men, 21 women, mean age 55±14 y) who underwent CDT for submassive PE between September 2009 and February 2017 were retrospectively reviewed. Mean t-PA rate was 0.7±0.3 mg/h. PAP was measured at baseline and daily until CDT termination. Mixed-effects regression modeling was performed of repeated PAP measures in individual patients. Bleeding events were classified by Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries (GUSTO) and t-PA dose at onset.ResultsMean t-PA dose was 43.0±30.0 mg over 61.9± 28.8 h. Mean systolic PAP decreased from 51.7±15.5 mmHg at baseline to 35.6±12.7 mmHg at CDT termination (p<0.001). Mixed-effects regression revealed a linear decrease in systolic PAP over time (β = -0.37 (SE = 0.05), p<0.001) with reduction in mean systolic PAP to 44.8±1.9 mmHg at 12 mg t-PA/20 h, 39.5±2.0 mmHg at 24 mg t-PA/40 h, and 34.9±2.1 mmHg at 36 mg/60 h. No severe, one moderate, and 8 mild bleeding events occurred; bleeding onset was more frequent at ≤24 mg t-PA (p <0.001). One patient expired from cardiopulmonary arrest after 16 h of CDT (15.4 mg t-PA); no additional intra-procedural fatalities occurred.ConclusionIncreased total t-PA dose and CDT duration were associated with greater PAP reduction without increased bleeding events.

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Section: Introductionsupporting

confidence: 67%

Tissue plasminogen activator dose and pulmonary artery pressure reduction in catheter directed thrombolysis of submassive pulmonary embolism

et al. 2019

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“…For the patients who received heparin, partial thromboplastin time was monitored every 6 hours for a target of 50-80 seconds. The CDT procedure was performed as previously described (8) using several types of infusion catheters either exclusively or in combination, including 5-Fr AP2 infusion angled pigtail catheters (Cook Medical, Bloomington, Indiana), EkoSonic Endovascular System catheters (EKOS Corp, Bothell, Washington), and Uni-Fuse multi-side-hole infusion catheters (Angiodynamics, Queensbury, New York). The infusion catheters were deployed either unilaterally or bilaterally, as determined by the operating physician, along with the choice of catheter ( Table 2).…”

Section: Methodsmentioning

confidence: 99%

Safety of Therapeutic Anticoagulation with Low-Molecular-Weight Heparin or Unfractionated Heparin Infusion during Catheter-Directed Thrombolysis for Acute Pulmonary Embolism

Graif

Kimbiris

Grilli

et al. 2020

Journal of Vascular and Interventional Radiology

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“…Some studies done in the past few years, however, have shown similar results when comparing ultrasound CDT with standard CDT [21][22][23]. A retrospective study done compared patients with submassive and massive PE receiving either CDT or ultrasound CDT.…”

Section: Trialmentioning

confidence: 98%

“…This study observed that both treatment modalities were equally effective in reducing pulmonary arterial pressures and miller index scores. They noted that fluoroscopy times were longer in the ultrasound CDT group, but complications and 30-day mortality rates were similar in both groups [23]. Although CDT is being used more frequently for submassive PE, physicians are still hesitant to use this treatment modality for patients presenting with massive PE, since the latter has a more dramatic clinical presentation.…”

Section: Trialmentioning

confidence: 99%

The Role of EkoSonic Endovascular System or EKOS® in Pulmonary Embolism

Khan¹,

Yamamura²,

Vargas³

et al. 2019

Cureus

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Pulmonary embolism has become a cause of great concern to health care professionals. Despite strides in research and availability of sensitive diagnostic tests, the mortality and morbidity related to this entity continues to cause tremendous economic burden. Patients present with an array of symptoms ranging from mild dyspnea to hemodynamic instability and even death. Prompt recognition of symptoms along with early risk stratification can be lifesaving. Management focuses on achieving hemodynamic stability and reducing clot burden. Approved treatment modalities include anticoagulation, systemic or catheter directed thrombolytic therapy and surgical embolectomy. In this article we will review catheter-directed thrombolytic therapy, specifically the EKOS® or the EkoSonic endovascular system. EKOS® uses ultrasoundfacilitated catheter-directed thrombolysis. The rationale behind this therapy is using shorter infusion times and lower dosage of the thrombolytic therapy, thereby reducing the complications associated with their use.

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Comparison of Ultrasound-Accelerated versus Pigtail Catheter–Directed Thrombolysis for the Treatment of Acute Massive and Submassive Pulmonary Embolism

Cited by 34 publications

References 26 publications

Tissue plasminogen activator dose and pulmonary artery pressure reduction in catheter directed thrombolysis of submassive pulmonary embolism

Tissue plasminogen activator dose and pulmonary artery pressure reduction in catheter directed thrombolysis of submassive pulmonary embolism

Safety of Therapeutic Anticoagulation with Low-Molecular-Weight Heparin or Unfractionated Heparin Infusion during Catheter-Directed Thrombolysis for Acute Pulmonary Embolism

The Role of EkoSonic Endovascular System or EKOS® in Pulmonary Embolism

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