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Catheter-Directed Thrombolysis for Submassive Pulmonary Embolism
Matthew A Chiarello1, Akhilesh K Sista2
1Department of Radiology, New York University - Langone School of Medicine, New York, New York.
Seminars in Interventional Radiology
|June 7, 2018
Summary
Catheter-directed thrombolysis (CDT) shows promise for treating submassive pulmonary embolism (PE) by improving radiographic outcomes with acceptable bleeding risks. Further research is needed to confirm long-term clinical benefits and safety.
Area of Science:
- Cardiology
- Pulmonary Medicine
- Interventional Radiology
Background:
- Acute pulmonary embolism (PE) is a significant cause of mortality.
- Submassive PE with right ventricular strain increases clinical deterioration and mortality risks.
- Systemic thrombolytics improve outcomes but carry high hemorrhage risks.
Purpose of the Study:
- To evaluate the efficacy and safety of catheter-directed thrombolysis (CDT) for submassive PE.
- To compare CDT with systemic thrombolysis regarding clinical outcomes and hemorrhage risk.
Main Methods:
- Analysis of three prospective trials (ULTIMA, SEATTLE II, PERFECT) evaluating CDT for submassive PE.
- Assessment of radiographic efficacy endpoints and rates of major hemorrhage.
Main Results:
- CDT demonstrated improvement in radiographic efficacy endpoints for submassive PE.
- The rates of major hemorrhage associated with CDT were acceptable.
- Current trials lack clinical endpoints and long-term follow-up data.
Conclusions:
- CDT appears to be a viable option for submassive PE, offering potential benefits over systemic thrombolysis.
- Further adequately powered and controlled trials are necessary to establish definitive short- and long-term effectiveness and safety.
- More research is required to determine the generalizability of current findings due to limitations in trial design and sample size.
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