Ultrasound-Assisted Thrombolysis in Submassive and Massive Pulmonary Embolism: Assessment of Lung Obstruction Before and After Catheter-Directed Therapy

Abstract

UA thrombolysis is promising in massive and submassive PE treatment and shows safe results. Patients showed improved thrombus burden, and rapid improvement in right cardiac function, whereas minimizing bleeding risk and ICU time were minimized. This results of this study provide the foundation for future comparative studies in treatment of large PEs.

Ultrasound-Accelerated Catheter-Directed Thrombolysis for Acute Submassive Pulmonary Embolism

“…compared favorably with the CDT group, in which only 50% of the patients had complete thrombus removal with a significantly longer thrombolytic infusion time of 26.7 hours and a hemorrhagic complication rate of 21.4%. Quintana et al (20) reported using tPA with USAT in 10 patients with acute massive or submassive PE. The median tPA dose and infusion time in their cohort was 18 mg (range, 7-38 mg) and 20.8 hours (range, 12-49 h), respectively.…”

“…The median tPA dose and infusion time in their cohort was 18 mg (range, 7-38 mg) and 20.8 hours (range, 12-49 h), respectively. Cessation of thrombolysis in these three studies was determined by the adequacy of thrombus removal on repeat pulmonary angiography (18,19) or repeat CT angiography (20).…”

“…Studies involving catheter-directed thrombolysis (CDT) with and without ultrasound have demonstrated a significant comparative improvement with RVD and pulmonary artery pressures without increased risk of major bleeding complication (17)(18)(19)(20)(21)(22). Some authors have suggested that catheter directed therapy be utilized in patients with contraindications to systemic thrombolysis as this population is at intermediate to high risk of death (23,24), however a variety of treatment algorithms were reported.…”

“…CDT and USAT in patients with acute massive and submassive PE(17)(18)(19)(20)(21)(22). An initial report by Chamsuddin et al(18) evaluated USAT with various thrombolytics and reported a 76% rate of complete thrombus removal after a median of 24 hours without any major hemorrhagic complications.…”

Ultrasound Assisted Catheter-Directed Thrombolysis of Acute Pulmonary Embolism: A Review of Current Literature

“…Some studies used a fixed dose of rt-PA (10mg over 15 hours) per treated lung, while other used pulse infusion or slow infusion [ 12 , 18 , 23 ]. Treatment duration also varied among studies and outcome is guided by clinical or angiographic measures [ 11 , 24 - 26 ].…”