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Catheter directed thrombolytic therapy and aspiration thrombectomy in intermediate pulmonary embolism with long term

Zoltan Ruzsa1, Zoltan Vámosi2, Balázs Berta3

  • 1Cardiac and Vascular Center, Semmelweis University, Városmajor str 68, 1122 Budapest, Hungary. zruzsa25@gmail.com.

Cardiology Journal
|April 25, 2020
PubMed

Insights

Catheter directed thrombolysis (CDT) is effective for intermediate pulmonary embolism (IPE), showing high success rates and reduced pulmonary pressures. Some patients required additional thrombectomy for optimal outcomes.

Area of Science:

  • Cardiology
  • Interventional Radiology
  • Pulmonary Medicine

Background:

  • Catheter directed thrombolysis (CDT) and thrombectomy are established treatments for intermediate pulmonary embolism (IPE).
  • The long-term effects of CDT for IPE remain largely unknown.
  • This study evaluates the outcomes of CDT in patients with IPE.

Purpose of the Study:

  • To assess the technical and clinical success of CDT in patients with intermediate pulmonary embolism.
  • To evaluate adverse events, mortality rates, and hemodynamic improvements following CDT.
  • To determine the long-term efficacy and safety of CDT for IPE.

Main Methods:

  • Retrospective analysis of clinical, interventional, and echocardiographic data from 80 consecutive IPE patients treated with CDT.
  • CDT involved alteplase infusion over 24 hours via a pig-tail catheter.
  • Primary endpoints included technical success and major adverse events; secondary endpoints included mortality, clinical success, bleeding, and hemodynamic changes.

Main Results:

  • CDT achieved technical success in 98.8% and clinical success in 96.3% of patients.
  • Mean pulmonary pressure significantly decreased post-treatment (57.5 to 38.9 mmHg, p < 0.001).
  • One-year major adverse events and cardiovascular mortality rates were low (4.0% and 1.4%, respectively), with 16.2% experiencing access site complications.

Conclusions:

  • Catheter directed thrombolysis demonstrates excellent results in submassive pulmonary embolism.
  • Adjunctive mechanical thrombectomy may be necessary in select cases to optimize clinical outcomes.
  • CDT is a safe and effective treatment option for intermediate pulmonary embolism.
Abstract

Keywords:
local thrombolysispulmonary embolism

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