Innovation in Catheter-Directed Therapy for Intermediate-High-Risk and High-Risk Pulmonary Embolism
Marco Zuin1, Irene Lang2, Romain Chopard3
1Department of Translational Medicine, University of Ferrara, Ferrara, Italy; Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Ferrara, Ferrara, Italy.
JACC. Cardiovascular Interventions
|October 17, 2024
Summary
Catheter-directed therapy (CDT) shows promise for acute pulmonary embolism (PE) but lacks robust data. Further research is needed to establish its role alongside anticoagulation for high-risk PE patients.
Area of Science:
- Cardiology
- Interventional Radiology
- Pulmonary Medicine
Background:
- Anticoagulation is standard for acute pulmonary embolism (PE).
- Catheter-directed therapy (CDT) is emerging for high-risk PE.
- Limited data exists comparing CDT with traditional treatments.
Purpose of the Study:
- To critically appraise current evidence for CDT in high-risk PE.
- To highlight innovations in CDT for PE.
- To identify unmet clinical and research needs in PE management.
Main Methods:
- Systematic review of existing literature on CDT for PE.
- Analysis of randomized controlled trials and observational studies.
- Evaluation of device selection strategies for CDT.
Main Results:
- Evidence supporting CDT's efficacy and safety in high-risk PE is limited.
- Randomized controlled data comparing CDT with anticoagulation alone is lacking.
- Innovations in CDT are rapidly evolving.
Conclusions:
- High-quality data is needed to guide guideline recommendations for CDT in PE.
- Further research should focus on comparative effectiveness and safety.
- Standardized approaches to device selection are required.
Related Concept Videos
01:29Pulmonary Embolism II: Diagnostic Studies and Interprofessional Care
3
Diagnosing Pulmonary EmbolismDiagnosing pulmonary embolism (PE) involves clinical assessment and advanced imaging tests. The preferred diagnostic tool is the spiral (helical) CT scan or CT angiography (CTA), which uses intravenous contrast media to visualize the pulmonary vasculature and identify emboli.A ventilation-perfusion (V/Q) scan is an alternative for patients unable to receive contrast media. This scan includes both perfusion and ventilation scanning. Perfusion scanning involves...
3
01:29Venous Thrombosis III: Interprofessional Care
3
Venous thrombosis requires effective prevention and treatment strategies to improve patient outcomes and reduce potential complications.Prevention StrategiesHealthcare providers must prioritize preventing venous thromboembolism (VTE) for all adult patients upon admission. Interventions depend on bleeding and thrombosis risk, medical history, current medications, diagnoses, planned procedures, and patient preferences. Patients on bed rest should change positions every two hours and, if not...
3
01:27Pulmonary Embolism III: Nursing Management
6
A pulmonary embolism occurs when a thrombus, amniotic fluid, tumor tissue, fat, or air embolus blocks one or more pulmonary arteries. Effective nursing management and patient education are crucial for improving outcomes and preventing recurrence.Nursing management starts with obtaining a comprehensive patient history, particularly noting any history of deep vein thrombosis (DVT). Assess for clinical manifestations, including dyspnea, chest pain, crackles, heart murmurs, and signs of right-sided...
6
01:27Peripheral Artery Disease III: Interprofessional Care
3
Peripheral Artery Disease (PAD) is characterized by narrowed arteries that diminish blood flow to the extremities. Effective management of PAD requires an interprofessional approach involving various healthcare professionals. The critical aspects of interprofessional care for PAD patients focus on risk factor modification, drug therapy, exercise therapy, nutrition therapy, critical limb ischemia care, and interventional radiology and surgical procedures.The primary treatment goal for PAD...
3
01:23Treatment for Pulmonary Arterial Hypertension: Prostacyclin Receptor Agonists
155
Prostacyclin receptor agonists are a class of therapeutic agents integral to managing pulmonary arterial hypertension (PAH). These drugs operate by mimicking the action of prostaglandin I2, or PGI2, a naturally occurring compound in the body.
These agonists bind to the IPR receptor situated on the plasma membrane of the pulmonary artery smooth muscle cells. This binding triggers a cascade of reactions known as the GS-AC-cAMP-PKA pathway. This pathway results in the relaxation of smooth muscle...
These agonists bind to the IPR receptor situated on the plasma membrane of the pulmonary artery smooth muscle cells. This binding triggers a cascade of reactions known as the GS-AC-cAMP-PKA pathway. This pathway results in the relaxation of smooth muscle...
155
01:26Treatment for Pulmonary Arterial Hypertension: Receptor Tyrosine Kinase Inhibitors and Calcium Channel Blockers
143
Receptor tyrosine kinase inhibitors (TKIs) and calcium channel blockers (CCBs) are two critical categories of drugs employed in the treatment of pulmonary artery hypertension (PAH). PAH is a disease that causes high blood pressure in the pulmonary arteries, resulting in chest pain, fatigue, and shortness of breath.
TKIs, such as imatinib (Gleevec), are particularly effective in tackling the growth and mitogenic factors that become upregulated in PAH patients. These factors contribute to the...
TKIs, such as imatinib (Gleevec), are particularly effective in tackling the growth and mitogenic factors that become upregulated in PAH patients. These factors contribute to the...
143