Future perspectives in catheter-based treatment of pulmonary embolism

Abstract

Pulmonary embolism is the third commonest cause of cardiovascular death globally. The majority of such patients present with low-risk features and can be managed with simple anticoagulation; however, a large group of patients exhibit evidence of right ventricular dysfunction on echocardiography or CT at the time of presentation and these patients are at risk of early haemodynamic compromise, particularly in those with abnormal cardiac biomarkers. Catheter-directed thrombolysis has been proposed as a treatment-strategy for patients with pulmonary embolism with evidence of acute right ventricular dysfunction. We review the current technologies in mainstream use, the evidence base in support of their use and discuss future research requirements in this area.

The clot thickens: role of mechanical thrombectomy in intermediate to high-risk pulmonary embolism in the peri-operative setting—a case report

“…Current ESC guidelines recommend catheter-directed thrombectomy in high-risk patients with absolute or relative contraindications to thrombolytics with risk for clinical deterioration, or in patients that have failed thrombolytic therapy (IIa, C). 1 , 3–5 In this case, our patient had no thrombolytic contraindication. However, given known increased risk of intracranial bleed with systemic thrombolysis, along with the higher risk for intracranial complication given the nature of spinal surgery, it was collectively decided by PERT and neurosurgery team that systemic thrombolysis posed overall higher relative risk.…”

“… 1 Though there is promising data on significant RV afterload reduction with catheter-directed therapy, 2 there is lack of randomized control data on enhanced clinical outcomes when catheter-directed therapy is compared against systemic anticoagulation. 3 In this case, the value of percutaneous catheter-directed mechanical thrombectomy in the urgent peri-operative setting where rescue reperfusion treatment is indicated is highlighted.…”

Short- and Long-Term Outcomes of Catheter-Directed Thrombolysis versus Pulmonary Artery Embolectomy in Pulmonary Embolism: A National Population-Based Study

“…Pulmonary embolism (PE) is one of the leading causes of cardiovascular mortality and morbidity worldwide. 1–5 The incidence of PE reportedly ranges from 39 to 115 per 100,000, 6 with significantly higher rates among the elderly. 7 Approximately one-third of PE patients present with sudden death or die within hours of presentation, 6 and up to 70% of deaths from PE occur within the first hour.…”

Unmet needs in the management of pulmonary embolism: catheter-directed therapy looks set to fill the void

“…A review of the currently available evidence regarding CDT by Chopard et al 8 summarizes the data coming from observational studies and clinical trials using the different devices. Finally, Sharp and Attallah 9 call for hard outcome data, which will shape the future of percutaneous approaches to PE management and would mandate it as a first-line treatment in any spectrum of the disease. We hope that this issue, with its comprehensive review of catheter-based therapies, will be a useful one-stop shop for the most up-to-date information on these promising techniques.…”