Percutaneous treatment options for acute pulmonary embolism: a clinical consensus statement by the ESC Working Group on Pulmonary Circulation and Right Ventricular Function and the European Association of Percutaneous Cardiovascular Interventions

Pruszczyk, Piotr; Klok, Frederikus A.; Kucher, Nils; Roik, Marek; Meneveau, Nicolas; Sharp, Andrew; Nielsen‐Kudsk, Jens Erik; Obradović, Slobodan; Giannini, Francesco; Stefanini, Giulio; Tarantini, Giuseppe; Konstantinides, Stavros; Dudek, Dariusz

doi:10.4244/eij-d-22-00246

Cited by 97 publications

(91 citation statements)

References 62 publications

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“…Actually, percutaneous catheter-directed treatment is recommended only in high-risk patients in whom thrombolysis is contraindicated or has failed and surgical embolectomy is not available (IIa class of recommendation) and in intermediate-risk patients with hemodynamic deterioration, because its benefits over medical or surgical therapy are still unclear. However, a clinical consensus statement by the ESC Working Group on pulmonary circulation and right ventricular function and the European Association of Percutaneous Cardiovascular Interventions has just been published and it proposed algorithm and timelines of catheter-directed therapies, demonstrating a growing clinical and scientific interest in this novel field ( 8 ).…”

Section: Discussionmentioning

confidence: 99%

“…We reported an early experience, in an Italian tertiary centre, of a high-risk patient treated with Inari Flow system, resulting in a fast improvement of vital signs and instant resolution of patient’ symptoms, without complications. Results of nine randomized clinical trials ( 8 ) are expected to demonstrate the superiority of percutaneous device treatments of PE over medical therapy, but based on our experience, percutaneous mechanical thrombectomy is an effective and safe alternative treatment for patients with PE at high and intermediate risk.…”

Section: Discussionmentioning

confidence: 99%

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Successful percutaneous catheter-directed treatment of high-risk pulmonary embolism: a case report

Russo¹,

Massaro²,

Sangiorgi³

2023

AME Case Rep

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Background Pulmonary embolism (PE) is an acute cardiovascular syndrome characterized by high incidence and mortality. The therapy of this condition is based on anticoagulation and hemodynamic support, but in case of high-risk mortality, the European Society of Cardiology (ESC) guidelines recommend systemic thrombolytic therapy and surgical embolectomy if thrombolysis is contraindicated or has failed; nowadays several percutaneous catheter-directed treatments for local thrombolysis or mechanical embolectomy are available, but they have IIa class of recommendation, because of lack of robust scientific evidence favoring their use. Case Description We described a case of high-risk PE treated with a novel percutaneous system for mechanical embolectomy, which consists of a large aspiration catheter that was advanced in the pulmonary artery, capturing and removing a vast thrombus, of 15 centimeters in length. This therapeutic strategy avoided the risk of hemorrhagic complications related to systemic thrombolysis, exiting in the achievement of fast patient hemodynamic stabilization and symptoms resolution, without complications. Computed tomography (CT) pulmonary angiography after 10 days from the intervention revealed the complete resolution of pulmonary artery filling defects, and the patient was discharged asymptomatic. Conclusions Percutaneous catheter-directed treatments represent an effective alternative therapy for PE, but further studies are needed to demonstrate safety and superiority over the actually recommended therapy.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Successful percutaneous catheter-directed treatment of high-risk pulmonary embolism: a case report

Russo¹,

Massaro²,

Sangiorgi³

2023

AME Case Rep

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“…The RoPE Score of our patient was 7 points, indicating a 72% chance that stroke was due to PFO. 16 The analysis of three important PFO trials demonstrated that patients with a RoPE Score ≥7 benefit from a higher-risk reduction of recurrent strokes when undergoing PFO closure than medical therapy alone. 17 In addition, the large size of the PFO, with more than 20 bubbles crossing, is associated with a causal role.…”

Section: Discussionmentioning

confidence: 99%

Unexpected paradoxical embolization following catheter-directed thrombectomy with the FlowTriever™ system in a patient with pulmonary embolism: a case report

Uecker

Rosenkranz

Bunck

et al. 2023

European Heart Journal - Case Reports

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Background The optimal therapy for patients suffering from acute pulmonary embolism classified as intermediate-high-risk still needs to be identified. Catheter directed thrombectomy (CDTE) is a safe procedure to reduce thrombus burden immediately. The lack of randomized trials is one reason, CDT hast not yet received a clear recommendation in our guidelines. Herein we report an unexpected event in the course of a patient with PE treated with CDTE using the FlowTrieverTM system, the only FDA approved catheter system for percutaneous mechanical thrombectomy regarding this indication. Case Summary A 57-year old male presented with dyspnea at the emergency department of our university hospital. The CT scan showed bilateral pulmonary embolism and ultrasound of the left lower limb revealed deep venous thrombosis. According to the current ESC guidelines he was classified intermediate-high risk. We performed bilateral catheter directed thrombectomy. On the first and third day post-intervention our patient presented neurological deficits. Whereas the first CT scan of the cerebrum remained normal, the CT-scan at day 3 showed demarcated embolic stroke. Further imaging diagnostic gave evidence to an ischemic lesion in the left kidney. Transesophageal echocardiography revealed a patent foramen ovale (PFO) as the origin of paradoxical embolism and thus mechanism of both ischemic lesions. Compliant to the current recommendations, percutaneous PFO-closure was performed. Our patient recovered properly without any sequelae. Discussion Whether the deep venous thrombosis is the source of embolization or the catheter directed retrieval of clots may have transported clot material to the right atrium which further on embolized systemically will remain unclear. Yet, we have to consider it as a potential complication in catheter directed treatment of pulmonary embolism in patients with a PFO.

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“…However, this consideration is classified as weak with a low level of evidence 87 . In 2022, the ESC Working Group on Pulmonary Circulation and Right Ventricular Function and the European Association of Percutaneous Cardiovascular Interventions published a consensus paper in which the authors emphasize that, although no robust data exist, there is a potential role for interventional therapies as an alternative reperfusion strategy at specialized centres 105 . Against this background and given the growing scientific and clinical interest in interventional therapies for PE, we summarize the available devices (Table 3 ) and discuss the published evidence and ongoing studies.…”

Section: Interventional Therapiesmentioning

confidence: 99%

Interventional therapies for pulmonary embolism

et al. 2023

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Pulmonary embolism (PE) is the leading cause of in-hospital death and the third most frequent cause of cardiovascular death. The clinical presentation of PE is variable, and choosing the appropriate treatment for individual patients can be challenging. Traditionally, treatment of PE has involved a choice of anticoagulation, thrombolysis or surgery; however, a range of percutaneous interventional technologies have been developed that are under investigation in patients with intermediate–high-risk or high-risk PE. These interventional technologies include catheter-directed thrombolysis (with or without ultrasound assistance), aspiration thrombectomy and combinations of the aforementioned principles. These interventional treatment options might lead to a more rapid improvement in right ventricular function and pulmonary and/or systemic haemodynamics in particular patients. However, evidence from randomized controlled trials on the safety and efficacy of these interventions compared with conservative therapies is lacking. In this Review, we discuss the underlying pathophysiology of PE, provide assistance with decision-making on patient selection and critically appraise the available clinical evidence on interventional, catheter-based approaches for PE treatment. Finally, we discuss future perspectives and unmet needs.

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Percutaneous treatment options for acute pulmonary embolism: a clinical consensus statement by the ESC Working Group on Pulmonary Circulation and Right Ventricular Function and the European Association of Percutaneous Cardiovascular Interventions

Cited by 97 publications

References 62 publications

Successful percutaneous catheter-directed treatment of high-risk pulmonary embolism: a case report

Successful percutaneous catheter-directed treatment of high-risk pulmonary embolism: a case report

Unexpected paradoxical embolization following catheter-directed thrombectomy with the FlowTriever™ system in a patient with pulmonary embolism: a case report

Interventional therapies for pulmonary embolism

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