Ultrasound-assisted lysis using recombinant tissue plasminogen activator and the EKOS EkoSonic endovascular system for treating right atrial thrombus and massive pulmonary embolism: A case study

Nw, Shammas; Padaria, R; Gk, Ahuja

doi:10.1177/0268355514555387

Cited by 11 publications

(14 citation statements)

References 18 publications

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“…However, in this study, 47.6% of the patients were women and 52.4% of them were men. Compared to the existing studies in this regard, the average age of the patients in this study was lower than other studies (Heijboer, Cogo, Buller, Prandoni, & ten Cate, 1992;Shammas, Padaria, & Ahuja, 2015).…”

Section: Discussioncontrasting

confidence: 75%

Comparison of the Precision of Compression Ultrasonography and Duplex Sonography in Deep Venous Thrombosis Patients

Reihani¹,

Ahmadi²,

Rezanejad³

et al. 2016

GJHS

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Deep venous thrombosis is a prevalent disease and difficult being detected which can be lethal if developed. Ultrasonography and duplex ultrasonography are two of the diagnostic methods with their restrictions. The present study addresses the analysis of the succession of compression ultrasonography as a method with less restrictions in comparison with ultrasonography and duplex ultrasonography. The present study was conducted in the central urgency section of Imam Reza Hospital, Mashhad, Iran, which is a public academic institute, on 70 patients in 2014. All patients were subjected to compression ultrasonography before duplex ultrasonography and those who had previous duplex ultrasonography sessions with available results were excluded from the investigations. Finally, the results of 63 patients were analyzed, 7 being excluded due to their inaccessible data. According to the results, 52 percent of subjects were males and 48 percent were females. The result of the regular ultrasonography was positive for 37 and negative for 26 patients. Duplex ultrasonography, however, led to positive results for 35 patients (equivalent to 37 lower limb organs) and negative results for 28 subjects (equivalent to 41 lower limb organs). The sensitivity, specificity, and precision of the diagnosis via compression ultrasonography were found to be 97, 90, and 93.5 percent, respectively, and the positive and negative predictive values were calculated to be 90 and 97 percent, respectively, with a CI of 95 percent. The diagnostic accuracy of 96.8% suggests that the use of compression sonography can be a good accuracy in the diagnosis of deep vein thrombosis of the lower extremities, but it cannot replace more accurate methods that are currently used as available selected diagnostic methods.

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Section: Discussioncontrasting

confidence: 75%

Comparison of the Precision of Compression Ultrasonography and Duplex Sonography in Deep Venous Thrombosis Patients

Reihani¹,

Ahmadi²,

Rezanejad³

et al. 2016

GJHS

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“…These methods are also promising in patients with RHT with some successful cases reported [18–21]. However evidence is still scarce and there is still a lack of general availability and expertise.…”

Section: Discussionmentioning

confidence: 99%

Pulmonary Embolism and Intracardiac Type A Thrombus with an Unexpected Outcome

Português

Calvo

Oliveira

et al. 2017

Case Reports in Cardiology

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Detection of right heart thrombi (RHT) in the context of pulmonary thromboembolism (PE) is uncommon (4–18%) and increases the risk of mortality beyond the presence of PE alone. Type A thrombi are serpiginous and highly mobile and are thought to be originated from large veins and captured in-transit within the right heart. Optimal management of RHT is still uncertain. A 79-year-old woman, with a history of recent total hysterectomy with adnexectomy and a Wells procedure, presented to the emergency department following an episode of syncope. Computed tomography revealed bilateral PE and the presence of a right atrial thrombus. Transthoracic echocardiography demonstrated a free-floating type A thrombus in the right atrium, protruding into the right ventricle, and signs of pulmonary hypertension and right ventricle dysfunction. Considering the recent surgery and clinical stability, treatment with heparin alone was decided. Subsequent clinical improvement was observed and echocardiographic follow-up revealed complete thrombus dissolution and complete recovery of right ventricle function. Most authors recommend treatment of PE with RHT with thrombolysis or embolectomy followed by anticoagulation, although evidence is scarce. Individual risk of hemorrhage and operatory-related mortality should be taken into account when defining the treatment strategy especially when benefit is not firmly established.

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“…To our knowledge, two prior cases were reported so far, both used in cases of right atrial thrombi that were not dialysis catheter associated, and both had concomitant PE. Nickel et al reported a case of failed EKOS use as 48 hrs later there was a residual occlusive thrombus in the suprarenal IVC extending to the cavoatrial junction that was successfully retrieved using the Vortex Angiovac system [ 9 ] while Shammas et al reported successful EKOS use with complete resolution of the thrombus 24 hours later as evidenced by echocardiogram [ 10 ]. We include a comparison between our case and prior reported cases of EKOS catheter use [ Table 1 ].…”

Section: Discussion and Review Of Literaturementioning

confidence: 99%

Ultrasound Assisted Catheter Directed Thrombolysis in the Management of a Right Atrial Thrombus: A New Weapon in the Armamentarium?

Shokr

Kaur

Belgrave

et al. 2016

Case Reports in Cardiology

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Catheter related thrombosis (CRT) is a commonly encountered entity fraught with substantial risk for mortality secondary to various complications including pulmonary embolism (PE), tricuspid regurgitation, endocarditis, right sided heart failure, and cardiogenic and septic shock. CRT carries a mortality rate of 18% in hemodialysis patients and more than 40% in nonhemodialysis patients. Management strategies include systemic anticoagulation, systemic thrombolysis, surgical evacuation, and percutaneous retrieval with no established guidelines. Ultrasound assisted catheter directed thrombolysis emerges as promising modality with a relatively lower risk of hemorrhage compared to systemic thrombolysis. We report a case of a 75-year-old man with dialysis catheter related thrombosis without PE for which ultrasound assisted catheter directed thrombolysis was used successfully as an alternative therapy.

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Ultrasound-assisted lysis using recombinant tissue plasminogen activator and the EKOS EkoSonic endovascular system for treating right atrial thrombus and massive pulmonary embolism: A case study

Abstract: This case report provides a new and an effective option to treat right atrial thrombus associated with a large pulmonary embolus leading to a good outcome.

Cited by 11 publications

References 18 publications

Comparison of the Precision of Compression Ultrasonography and Duplex Sonography in Deep Venous Thrombosis Patients

Comparison of the Precision of Compression Ultrasonography and Duplex Sonography in Deep Venous Thrombosis Patients

Pulmonary Embolism and Intracardiac Type A Thrombus with an Unexpected Outcome

Ultrasound Assisted Catheter Directed Thrombolysis in the Management of a Right Atrial Thrombus: A New Weapon in the Armamentarium?

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